Panado v. Board of Trustees Employees' Retirement System State of Hawaii . , 134 Haw. 1 ( 2014 )


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  •    *** FOR PUBLICATION IN WEST’S HAWAI#I REPORTS AND PACIFIC REPORTER ***
    Electronically Filed
    Supreme Court
    SCWC-13-0000022
    11-JUL-2014
    07:45 AM
    IN THE SUPREME COURT OF THE STATE OF HAWAI#I
    ---o0o---
    EDEN L. PANADO, Petitioner/Appellant-Appellant,
    vs.
    BOARD OF TRUSTEES, EMPLOYEES’ RETIREMENT SYSTEM, STATE OF HAWAII,
    Respondent/Appellee-Appellee.
    SCWC-13-0000022
    CERTIORARI TO THE INTERMEDIATE COURT OF APPEALS
    (CAAP-13-0000022; CIV. NO. 12-1-0151)
    JULY 11, 2014
    RECKTENWALD, C.J., NAKAYAMA, McKENNA, AND POLLACK, JJ., AND
    CIRCUIT JUDGE CASTAGNETTI, ASSIGNED BY REASON OF VACANCY
    OPINION OF THE COURT BY RECKTENWALD, C.J.
    The instant case arises from Eden Panado’s application
    for service-connected disability retirement with the Board of
    Trustees of the Employees’ Retirement System of the State of
    Hawai#i.   In her application, Panado alleged that she was
    permanently incapacitated because of neck and back injuries she
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    sustained while lifting boxes during an October 8-9, 2004 work
    shift for the City & County of Honolulu’s Department of
    Information Technology.      The statute at issue in this case,
    Hawai#i Revised Statutes (HRS) § 88-79, allows for service-
    connected disability retirement benefits if a member of the ERS
    can show that he or she was “permanently incapacitated for duty
    as the natural and proximate result of an accident occurring
    while in the actual performance of duty at some definite time and
    place . . . .”
    The Board of Trustees denied Panado’s application.
    Although the parties stipulated that Panado had suffered an
    injury sometime during her October 8-9, 2004 work shift, and that
    she was permanently incapacitated for work by the time of her
    application, the Board of Trustees determined that (1) Panado’s
    October 8-9, 2004 injury was not an “accident” under HRS § 88-79
    because she had failed to show that the injury occurred at “some
    definite time and place”; and (2) Panado’s permanent incapacity
    was not the “natural and proximate result” of the October 8-9,
    2004 incident.
    Panado appealed to the Circuit Court of the First
    Circuit (circuit court), which affirmed the Board of Trustees’
    decision because Panado had failed to show that the incident
    occurred at “some definite time and place.”          The circuit court
    did not address the other reason for the Board of Trustees’
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    denial of Panado’s application, i.e., that she failed to prove
    her incapacity was the natural and proximate result of the
    alleged accident.    A majority of the Intermediate Court of
    Appeals (ICA) affirmed the decision.
    In her Application for Writ of Certiorari, Panado
    asserts that:    (1) the ICA erred in affirming the circuit court’s
    conclusion that Panado’s injuries during a single eight-hour work
    shift did not occur at a “definite time and place” under HRS
    § 88-79[1] and Hawai#i Administrative Rule (HAR) § 6-22-8,[2] and
    1
    HRS § 88-79(a) (Supp. 2007) provides in relevant part that:
    Upon application of a member, or the person appointed
    by the family court as guardian of an incapacitated
    member, any member who has been permanently
    incapacitated for duty as the natural and proximate
    result of an accident occurring while in the actual
    performance of duty at some definite time and place,
    or as the cumulative result of some occupational
    hazard, through no wilful negligence on the member’s
    part, may be retired by the board for
    service-connected disability[.]
    2
    HAR § 6-22-8 (effective 2009-2014) provides that:
    Upon completion of the examination of the member and
    the reports submitted to it, the medical board shall
    certify in writing to the board the following:
    (1)   In the case of an application for ordinary
    disability or service-connected disability
    retirement, whether or not the incapacity is:
    (A)   For the further performance of duty; or
    (B)   For gainful employment; and
    (C)   Likely to be permanent.
    (2)   In the case of an application for
    service-connected disability retirement or for
    accidental death benefits, whether or not the
    incapacity or death is:
    (A)   The natural and proximate result of an
    accident occurring while in the actual
    performance of duty at some definite time
    and place; or
    (B)   The cumulative result of some occupational
    hazard (in the case of service-connected
    (continued...)
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    (2) the evidence in this case demonstrates a causal connection
    between the October 8-9, 2004 incident and her permanent
    incapacity.
    We agree with Panado that the “definite time and place”
    language in HRS § 88-79 does not preclude the recovery of
    benefits despite her inability to pinpoint the precise moment of
    injury when, as in the instant case, there is no dispute that
    Panado was injured during her work shift.           However, we remand the
    case to the circuit court for it to determine the Board of
    Trustees’ second ground for denying Panado’s application, namely,
    that her permanent incapacity is not “the natural and proximate
    result of the alleged incident.”
    II.   Background
    A.     Factual Background
    The following factual background is taken from the
    record on appeal.
    On October 8-9, 2004, Panado was working as a Computer
    Operator III with the City & County of Honolulu (City & County)
    Department of Information Technology.           During her work shift,
    which ran from 11:30 p.m. on October 8 to 7:45 a.m. on October 9,
    2
    (...continued)
    disability retirement) or the result of
    some occupational hazard (in the case of
    accidental death benefits); and
    (C)   Through no wilful negligence on the part
    of the member.
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    2004, she was assigned to print voter registration forms and had
    to lift 10-15 boxes of paper.        The following day, on October 10,
    2004, Panado was admitted to the emergency room at Tripler
    Hospital for treatment of neck and low back pain.            From
    October 9, 2004 to October 5, 2005, Panado was unable to return
    to work.
    On October 12, 2004, Panado applied for workers’
    compensation and began to receive temporary total disability
    benefits from the City & County.        As a result, the City & County
    required Panado to undergo several independent medical
    evaluations (IME).      Deborah Agles, M.D., performed an IME of
    Panado on January 11, 2005, diagnosing her with lumbosacral and
    cervical strains.     Dr. Agles noted that, “[a]t present time, I
    believe that the patient is unable to work, and should continue
    on temporary total disability benefits.”          Explaining that
    Panado’s “prognosis is guarded because of the diffuse nature of
    pain symptoms, . . . hyperreflexia[,][3]” and “subjective symptoms
    which are not completely concordant with objective studies,”                Dr.
    Agles noted, however, that Panado “presented in an honest and
    3
    “Hyperreflexia” is defined as “exaggeration of the reflexes.”   The
    Sloane-Dorland Annotated Medical-Legal Dictionary 355 (1987).
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    reliable manner; there were no overt pain behaviors, and no
    evidence of malingering or secondary gain.[4]”
    Dr. Agles submitted a supplemental report on June 14,
    2005, after reviewing Panado’s medical records.           Dr. Agles opined
    that:
    the patient’s current symptoms are not completely
    attributable to the incident of 10/09/04. The
    10/09/04 accident may have caused an exacerbation of
    her low back condition, but her low back was already
    symptomatic and receiving active medical care in close
    proximity to the subject injury (four days prior).
    The medical records do not support a pre-existing
    cervical spine condition, although x-rays were
    obtained of the neck in 1989, and there was a motor
    vehicle accident in 1994, with intermittent symptoms
    in the bilateral upper extremities.
    Dr. Agles further opined that “the incident of 10/09/04
    did cause an injury to the cervical spine” and that “[t]he low
    back can be considered at pre-injury state[.]”           Dr. Agles noted
    that Panado’s records indicated she had longstanding
    fibromyalgia, and that the “pain [Panado] experiences from
    fibromyalgia is complicating her presentation; this diagnosis is
    important, and was not discussed by the patient when a past
    medical history was obtained.”
    Panado returned to work on October 6, 2005.              She was
    assigned to light duty and not permitted to carry anything heavy.
    4
    “Secondary gain” is defined as “a secondary psychic or social
    advantage derived from a symptom or illness[,]” such as when a physical
    illness “might result in a pension for [an] individual[.]” The Sloane-Dorland
    Annotated Medical-Legal Dictionary 305.
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    On October 24, 2005, another IME was performed by
    Donald K. Maruyama, M.D.        Based on his examination of Panado and
    review of her records, including Dr. Agles’ report, Dr. Maruyama
    stated that:
    Dr. Agles felt that [Panado] had reached her pre-
    injury status with regard to her lower back and lower
    extremity symptoms and her opinion was that her
    ongoing symptomatology in her low back and lower
    extremities was due to a pre-existing condition. I
    generally tend to agree although there may be at least
    mild permanent aggravation of her ongoing low back and
    right lower extremity symptomatology, at least from
    the subjective standpoint. Her cervical and right
    upper extremity symptoms appear to be a direct result
    of the October 9, 2004 incident although her chronic
    fibromyalgia situation does contribute to her overall
    musculoskeletal symptoms.
    Dr. Maruyama also stated that “Panado has returned to
    her usual and customary duties of Computer Operator III at the
    City & County.      A review of the position description reveals that
    she can probably perform all of the duties as described.”
    Panado was again off of work from January 26, 2006 to
    March 5, 2006.      On March 30, 2006, Panado was medically
    disqualified from work by her primary treating physician, Diokson
    Rena, M.D., because she was “unable to perform and tolerate [her
    work] duty despite restrictions.”
    B.     Proceedings relating to Panado’s eligibility for benefits
    On May 1, 2006, Panado filed an Application for
    Disability Retirement with the ERS.          In her application, she
    stated that on October 9, 2004, as a “Computer Operator III,
    Department of Information Technology, Operations Division,” she
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    was “printing voters’ registration forms on 2 impact printers and
    while lifting forms to load & unload between printers, felt pain
    in lower back, upper back, shoulder, neck, & right arm.              Next day
    was more intense pain & barely able to move the following day.”
    On July 12, 2007, Dr. Lichter, a former chair of the
    ERS Medical Board, performed a medical records review for ERS.
    Among the records reviewed were the independent medical
    examinations by Dr. Agles and Dr. Maruyama, reports by her
    treating physician Dr. Rena, and Panado’s military medical
    records.   Dr. Lichter’s report stated:
    I strongly disagree with Dr. Maruyama’s [October 24,
    2005] opinion that “there may be at least a mild
    permanent aggravation of her ongoing low back and
    right lower extremity symptomatology. . .” His
    opinion is based only, as he stated, on a “subjective
    standpoint.” This latter opinion indicates that
    [Pando’s] self-serving reports are the primary basis
    of his opinion which is essentially contrary to the
    objective evidence.
    The omission by [Panado] of any reference to her pre-
    existing, properly diagnosed and repeatedly treated
    illness leads the undersigned to believe that there is
    a strong chance that [Panado’s] claim is not only
    worthless but may be fraudulent.
    Although Dr. Lichter already expressed an opinion, and
    notably a very negative one, the Board of Trustees selected him
    to perform another IME on Panado, which he did on October 24,
    2007.   In his accompanying report, Dr. Lichter concluded that
    Panado’s incapacitation stemmed from “non-organic” causes and not
    from the injuries she suffered from lifting the boxes.              During
    the physical examination of Panado, Dr. Lichter recognized the
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    presence of several Waddell signs, which are a group of
    inappropriate responses to physical examination that indicate
    non-organic or psychological causes of pain.5          Performing a test
    for “distraction,” in which a straight leg raise is performed
    while the patient is lying flat, then, while distracting the
    patient, another straight leg raise is done while the patient is
    seated, Dr. Lichter reported that Panado showed a marked
    difference in pain response to the two leg raises even though the
    pain response should be consistent.         Dr. Lichter also observed
    the presence of other Waddell signs such as “over-reaction,”
    “regional disturbances,” and simulation.          Dr. Licther noted that
    “[t]wo or more of these findings strongly suggest a psychological
    basis for some or all of [Panado’s] complaints.”
    Based on these tests and a review of Panado’s medical
    records, Dr. Lichter diagnosed Panado as having (1) “Chronic neck
    and back pain due to herniated nucleus pulposes at C 4-5 and L5-
    S1, probably secondary to a motor vehicle accident in 1994”; and
    (2) “Failure to cope with situational stress and mild permanent
    residuals of #1.”     Dr. Lichter also reiterated that Panado’s
    failure to mention her preexisting fibromyalgia led him to
    believe that her claim may be fraudulent.
    5
    See Gordon Waddell et al., Nonorganic Physical Signs in Low-Back
    Pain, Spine March/April 1980, at 117-25.
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    On November 12, 2007, the Medical Board issued its
    report, which summarized the facts and pertinent medical records
    regarding Panado, then stated its findings:
    The findings of the undersigned [Medical] Board are
    that [Panado] is permanently incapacitated for the
    further performance of duty, but that such incapacity
    is not the natural and proximate result[6] of an
    accident that occurred while in the actual performance
    of duty at a specific place and time, and not the
    cumulative result of an occupational hazard as
    explained above.
    Based on these findings, the Medical Board recommended
    that Panado be denied service-connected disability retirement.
    Panado appealed the decision of the Medical Board to
    the Board of Trustees.      At the January 19, 2010 hearing on her
    appeal, the parties stipulated to Panado being “physically or
    mentally incapacitated with [regard to the] further performance
    of duty as a Computer Operator III”; that “such incapacitation is
    likely to be permanent”; and that “such incapacitation is not the
    result of willful negligence on the part of Ms. Panado.”             The
    parties also stipulated that “on the date of the injury on
    October 9, 2004, that [Panado was] working in [her] job as the
    Computer [Operator III].”
    Patricia L. Chinn, M.D., Medical Board Chairperson,
    appeared for the Medical Board as an expert witness in medicine
    and general surgery and testified that, in the Medical Board’s
    6
    HAR § 6-22-2 (effective 1984-2014) defines “Natural and proximate
    result” as “the result that would naturally follow from the accident, unbroken
    by any independent cause.”
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    view, “accident” under HRS § 88-79 “needs to occur at a specific
    date and time.    It’s not over a stretch of hours.         It is not
    something that occurs and then developed symptoms the following
    day.”   Dr. Chinn further explained:
    A:    [The] ERS definition of accident is pretty
    clear. It’s got to occur at a specific date and
    time and in general, there’s an immediate
    complaint of pain or disability. When somebody
    develops pain the following morning, that for
    most physicians is related to an overuse, muscle
    over use or a strain, muscle strain, which
    generally is self resolving.
    Q:    What about gradual onset of pain while you’re
    performing an activity?
    A:    That doesn’t follow the definition of an
    accident. Generally it’s like immediate. I
    don’t think you can record snapping my fingers,
    but it’s an immediate occurrence and you are
    aware that something happened at that time. And
    you can, you know, as you –- I mean if I were to
    get up and I were to lift multiple boxes and I
    have neck problems and I have a disk, and I’ve
    had problems with my neck and my back, I could
    move multiple boxes and I might gradually
    develop discomfort as my muscles tensed.
    And maybe I’m a little bit out of joint and
    maybe because I’m a little deconditioned, but
    the fact that I might develop pain over a period
    of time with an associated activity does not
    constitute an accident. That’s clearly against
    the definition of accident for the Medical Board
    purposes.
    The Hearing Officer issued her Recommended Decision on
    June 29, 2010, including the following Findings of Fact:
    3.    Petitioner described the October 9, 2004 alleged
    accident in her Application as “[p]rinting
    voters’ registration forms on 2 impact printers
    and while lifting forms to load & unload between
    printers, felt pain in lower back, upper back,
    shoulder, neck & right arm. Next day was more
    intense pain & barely able to move the following
    day.”
    . . .
    12.   Petitioner had fibromyalgia during all relevant
    times in this case.
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    13.   The October 9, 2004 incident did cause injury to
    Petitioner’s cervical spine.
    14.   Petitioner sustained a temporary aggravation of
    her lower back condition on October 9, 2004, but
    was back at pre-injury state by the October 24,
    2005 date of Dr. Maruyama’s IME.
    15.   Notwithstanding Petitioner’s cervical and low
    back problems, Petitioner had returned to work
    and was able to perform all of the duties of her
    full-time job by the October 24, 2005 date of
    Dr. Maruyama’s IME.
    16.   Dr. Maruyama’s opinion that “there may be at
    least a mild permanent aggravation of
    Petitioner’s low back and right lower extremity
    symptomatology” was based only on a subjective
    standpoint (i.e., Petitioner’s self-serving
    reports) and is contrary to the objective
    evidence.
    . . .
    20.   Petitioner is permanently incapacitated for the
    further performance of duty as a Computer
    Operator III.
    21.   The October 9, 2004 incident does not constitute
    an accident for purposes of disability
    retirement under Chapter 88, HRS.
    22.   Petitioner’s permanent incapacity is not the
    natural and proximate result of the alleged
    accident.
    The Hearing Officer also proposed the following
    Conclusions of Law:
    2.    Petitioner has failed to prove by a
    preponderance of the evidence that her
    incapacity for further performance of duty was
    (a) the natural and proximate result of an
    accident which occured October 9, 2004 or (b)
    the cumulative result of an occupational hazard,
    as required by HRS § 88-285 and § 88-79.
    3.    Petitioner is not entitled to service-connected
    disability retirement.
    Based on the above findings and conclusions, the
    Hearing Officer recommended that the Board of Trustees deny
    service-connected disability retirement benefits to Panado.             On
    September 20, 2010, the Board of Trustees issued a Proposed
    Decision that adopted the Hearing Officer’s Recommended Decision,
    including the Hearing Officer’s findings of fact and conclusions
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    of law.   The Board of Trustees’ December 16, 2011 Final Decision
    affirmed its Proposed Decision and also adopted the Hearing
    Officer’s Recommended Decision, findings of fact, and conclusions
    of law.   Accordingly, the Board of Trustees denied Panado’s
    application for service-connected disability retirement benefits.
    On January 17, 2012, Panado timely appealed the Final
    Decision to the circuit court.        In her opening brief before the
    circuit court, Panado challenged the Board of Trustees’
    determination that (1) the October 8-9, 2004 incident was not an
    “accident” and (2) the incapacity was not the natural and
    proximate result of the October 8-9 incident.            Panado argued that
    the facts of the instant case are “virtually identical” to Myers
    v. Board of Trustees of Employees’ Retirement System, 
    68 Haw. 94
    ,
    95, 
    704 P.2d 902
    , 903 (1985).7        Thus, because the incident in
    7
    In Myers, a state employee was lifting an approximately thirty-
    five pound coffee maker to prepare to conduct a training class when he heard a
    snap in his 
    back. 68 Haw. at 95
    , 704 P.2d at 903. He experienced sharp pains
    across his lower back and buttocks and eventually became disabled. 
    Id. The Board
    of Trustees rejected his application for service-connected total
    disability retirement. 
    Id. at 95,
    704 P.2d at 904. The circuit court
    reversed the Board of Trustees’ decision and order. 
    Id. In its
    appeal to
    this court, the Board of Trustees argued that Myers’ incident was not an
    “accident” within the meaning of HRS § 88-77, and the Board of Trustees was
    not clearly erroneous in deciding that Meyers’ incapacitation was not the
    natural and proximate result of the coffee maker incident. 
    Id. at 95-96,
    704
    P.2d at 904.
    Because the facts were not in dispute, this court stated that
    whether or not the incident was an “accident” was a question of law. 
    Id. at 96,
    704 P.2d at 904. The Myers court then defined “accident” as “an unlooked
    for mishap or untoward event which is not expected or designed,”•id. (quoting
    Lopez v. Bd. of Trs. of ERS, 
    66 Haw. 127
    , 130, 
    657 P.2d 1040
    , 1043 (1983)),
    and concluded that “[s]ince the . . . incident was, beyond question, an
    unlooked for mishap which was not expected or designed, it was an
    ‘accident[,]’” Myers, 68 Haw. at 
    96, 704 P.2d at 904
    .
    On the second issue, whether the accident was the proximate cause
    of Myers’ incapacitation, this court stated that the “question of causal
    (continued...)
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    Myers was determined to be an accident, the incident in the
    instant case should also be an accident.          Panado next argued that
    the medical opinions by Dr. Rena, Dr. Maruyama, and Dr. Agles
    established “a causal connection between the October 9, 2004
    accident and [Panado’s] incapacity.”
    In its answering brief, the Board of Trustees argued
    that “[w]hether Ms. Panado was entitled to disability retirement
    . . . is a mixed question of fact and law” subject to review
    under the clearly erroneous standard, and not, as Panado
    contended, a question of law.        The Board of Trustees also argued
    that the clearly erroneous standard of review applied because the
    Board disputed whether Panado’s incapacity was the natural and
    proximate result of the accident, and whether Panado’s “permanent
    incapacity was due to the natural worsening of her significant
    preexisting low back problems,” rather than any accident on
    October 8-9, 2004.      The Board of Trustees explained that Panado’s
    case was distinguishable from Myers because Myers “could point to
    a definite time and place when the accident occurred.”             (Emphasis
    in the original).
    The Board of Trustees next contended that, “even if
    this Court found the events of October 9th met the definition of
    7
    (...continued)
    connection is . . . basically a matter of medical opinion.” 
    Id. at 97,
    704
    P.2d at 905. Based upon its review of the record, including the opinions of
    various doctors, this court concluded that the Board of Trustees clearly erred
    in finding “no causal connection.” 
    Id. Accordingly, the
    Myers court affirmed
    the circuit court’s order.
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    accident under HRS § 88-79, Ms. Panado would not be entitled to
    receive service-connected disability retirement benefits since
    her incapacity was not the ‘natural and proximate result’ of the
    events of October 9th.”      The Board of Trustees explained that it
    had found her permanent injuries were not caused by the events of
    October 9th, but rather by preexisting degenerative medical
    conditions and injuries.
    In her reply brief, Panado argued that the issue was a
    question of law because there was no dispute between her and the
    Board of Trustees that she was injured while working her shift.
    The only question for the circuit court was whether the events
    that occurred constitute an “accident.”         Panado contended that
    the Board of Trustees read the phrase “definite time and place”
    too narrowly in requiring her to “establish the exact moment” she
    was injured.   (Emphasis in the original).        Panado also argued
    that the medical opinions of Dr. Agles, Dr. Maruyama, and Dr.
    Rena all show that the October 8-9 accident proximately caused
    Panado’s incapacity.
    On September 14, 2012, the circuit court held a hearing
    on Panado’s appeal.     Panado’s counsel stated, “we concede
    essentially that we can’t probably pinpoint to the exact box that
    she picked up [at which time the accident] may have occurred”;
    however, because the parties agreed that Panado suffered an
    injury during her work shift, the issue upon which the case
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    hinged was a question of law, namely, whether HRS § 88-79
    required a showing of the precise moment and place of injury to
    constitute an “accident” or whether it was enough to show, as
    Panado did, that she was injured during her work shift.              The
    court stated:
    So let’s say assuming arguendo that it was around an
    eight-hour shift. And during the course of her shift,
    her job required her to either lift, push, pull, that
    type of activity with respect to these boxes. So
    during a period of time.
    Now, whether or not this type of activity over a
    course of an eight-hour shift constitutes an accident
    at some definite time and place, the Court will say
    that given its plain ordinary meaning, the answer is
    no. And we only have the [Myers] case. But even the
    [Myers] case did not look at the accident definition,
    injecting at some definite time and place.
    The Court will interpret the definition as definite
    time and place which these facts do not apply. So
    it’s a conclusion.
    And in terms of mixed question of fact and law, I
    don’t think the facts are disputed as to what she was
    doing during the eight-hour period of time. What was
    in dispute was the description to the various doctors.
    But that –- the Court is going to set that aside for
    its analysis.
    So even assuming all of that took place, whether it’s
    one box, two boxes, several boxes, hour one, hour two,
    over the course of eight hours, the facts –- the facts
    and –- do not constitute an accident at some definite
    time and place with the emphasis on that.
    So the –- affirmed.   And the appeal is being
    dismissed.
    On November 9, 2012, the circuit court issued its
    decision and order affirming the Board of Trustees’ final
    decision.    The circuit court determined:
    5.    [Panado] described the “accident” as
    “repetitively lifting & moving heavy boxes”
    during the course of her shift; however,
    [Panado] did not establish a specific time or
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    event during the course of [Panado’s] eight-hour
    shift when her claimed “accident” occurred.
    . . .
    7.     Given the plain and ordinary meaning of “at some
    definite time and place” in HRS § 88-79 and HAR
    6-22-4, the Court concludes that repetitive
    lifting and moving of heavy boxes during the
    course of [Panado’s] eight hour shift does not
    constitute an “accident” for purposes of
    determining whether [Panado] is entitled to
    service connected disability retirement benefits
    under HRS §§ 88-285 and 88-79.
    8.     The Court finds that [the Board of Trustees] did
    not commit any error in law or fact in its
    determination that [Panado’s] incapacity is not
    the result of an accident that occurred on
    October 9, 2004.
    Based on these determinations, the circuit court
    affirmed the Final Decision of the Board of Trustees.                  The
    circuit court entered final judgment on December 13, 2012.
    Panado timely appealed.
    C.     ICA Appeal
    In her opening brief, Panado reiterated that the
    October 8-9, 2004 incident was virtually identical to the facts
    under Myers, in which this court held that Myers’ incapacity from
    lifting the coffee maker was a compensable injury.              Panado next
    argued that the circuit court “erred in too narrowly construing
    ‘definite time and place’” to preclude her claim because she
    could not point to her exact moment of injury.8             Panado again
    relied on Myers, observing that nothing in Myers required Panado
    to “demonstrate her injury with such precision.”
    8
    Consistent with her counsel’s concession in oral argument in the
    circuit court, Panado argued that she injured herself while lifting
    “approximately 10-15 heavy boxes of Xerox paper,” rather than suggesting that
    she was injured while lifting or dropping a particular box.
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    In its answering brief, the Board of Trustees contended
    that the ICA should apply a more deferential, clearly erroneous
    standard of review to the issue on appeal because it was a mixed
    question of law and fact rather than a question of law.
    Specifically, the Board of Trustees characterized the issue as a
    mixed question of law and fact because the “legal conclusion that
    [Panado’s] alleged October [8-]9 2004 incident occurred at a
    ‘definite time and place’ is dependent upon the particular facts
    and circumstances surrounding her alleged injuries.”            The Board
    of Trustees also argued that the ICA should give proper deference
    to its interpretation of HRS § 88-79 because it is the agency
    charged with administering the statute.         The Board of Trustees
    then maintained that Myers was distinguishable from the instant
    case because Myers could point to a specific time of injury, and
    thus would satisfy the Board’s interpretation of HRS § 88-79’s
    “definite time and place” as requiring proof of the exact moment
    of injury.
    In her reply brief, Panado argued that the proper
    standard of review is de novo because the determinative issue was
    how to interpret HRS § 88-79’s “definite time and place”
    language.    According to Panado, the parties agreed on the events
    at issue, namely, that Panado was injured while working her shift
    on October 8-9, 2004.     However, the issue the parties did not
    agree on, and that the ICA must decide on appeal, is whether the
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    events at issue constitute an “accident” that occurred at some
    “definite time and place” under HRS § 88-79.
    On November 26, 2013, a majority of the ICA issued an
    SDO that affirmed the circuit court’s November 9, 2012 decision
    and order.    The majority held that (1) the instant case was
    distinguishable from Myers and that (2) the circuit court’s
    construal of “a definite time and place” was not clearly
    erroneous.    Specifically, the majority concluded that Myers was
    distinguishable because the facts in Myers were undisputed,
    whereas in Panado’s case, there was a dispute about whether her
    injury arose over the course of her eight-hour shift or at a
    particular moment,9 and whether the injury was a permanent or
    temporary aggravation of preexisting injuries.           The majority
    emphasized that the facts in the instant case were disputed, and
    rejected Panado’s contention that the material facts, i.e., that
    the alleged accident occurred at her workplace during her eight-
    hour work shift, were undisputed.          Accordingly, the majority
    rejected Panado’s argument that it should apply a de novo
    standard of review.
    The majority instead concluded that the issue under
    review was more accurately characterized as a mixed question of
    law and fact regarding “whether the circuit court erred by
    9
    However, as noted, supra note 8, Panado abandoned her argument
    that she was injured when she dropped a particular box.
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    narrowly construing the phrase ‘a definite time [and] place’ as
    used in HRS § 88-79(a) and HAR § 6-22-2 to exclude the
    ‘repetitive lifting and moving of heavy boxes during the course
    of [Panado’s eight-hour] shift[.]’”        (Citing Camara v. Agsalud,
    
    67 Haw. 212
    , 216, 
    685 P.2d 794
    , 797 (1984)) (brackets in the
    original).   Based on this conclusion, the majority applied a
    clearly erroneous standard to the circuit court’s decision and
    held that, “the circuit court’s construal of ‘a definite time and
    place’ was not clearly erroneous.”        Accordingly, the ICA affirmed
    the circuit court’s December 13, 2012 final judgment.
    In a dissenting opinion, Chief Judge Nakamura stated
    that the circuit court erred, as a matter of law, in ruling that
    “Panado’s description of how she was injured was insufficient to
    satisfy the requirement of HRS § 88-79 that the work accident
    occur ‘at some definite time and place.’”         According to Chief
    Judge Nakamura, the standard of review should be de novo because
    the case turned on a question of statutory interpretation, more
    specifically, the meaning of “at some definite time and place.”
    Chief Judge Nakamura concluded that the legislative intent for
    the “at some definite time and place” language was to limit
    qualifying accidents to those that are clearly work related.
    Noting that it was undisputed that Panado injured herself as a
    result of lifting boxes during her October 9, 2004 work shift,
    Chief Judge Nakamura then concluded that “Panado’s inability to
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    specifically attribute her injuries to a particular box lifted or
    pinpoint the exact time during the eight-hour shift that she
    sustained injuries did not detract from the fact that she clearly
    suffered injuries as the result of a work-related accident.”
    Thus, Panado’s description of her injuries was sufficient to meet
    the “at some definite time and place” requirement.             For these
    reasons, Chief Judge Nakamura would have vacated the circuit
    court’s decision and order and remanded the case to the circuit
    court to rule on the Board of Trustees’ alternative ground for
    denying Panado’s application, i.e., that she failed to
    demonstrate that her incapacitation was the natural and proximate
    result of the October 9, 2004 incident.
    The ICA filed its judgment on January 3, 2014.            On
    March 4, 2014, Panado timely filed the instant application for a
    writ of certiorari.       The Board of Trustees filed a response on
    March 19, 2014.
    III.   Standards of Review
    A.     Review of agency decisions
    Review of a decision made by the circuit court upon
    its review of an administrative decision is a
    secondary appeal. Ahn v. Liberty Mut. Fire Ins. Co.,
    126 Hawai#i 1, 9, 
    265 P.3d 470
    , 478 (2011) (citation
    omitted). The circuit court’s decision is reviewed de
    novo. 
    Id. The agency’s
    decision is reviewed under
    the standards set forth in HRS § 91-14(g). 
    Id. HRS §
    91-14(g) (1993) provides:
    (g)   Upon review of the record the court may affirm
    the decision of the agency or remand the case
    with instructions for further proceedings; or it
    may reverse or modify the decision and order if
    the substantial rights of the petitioners may
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    have been prejudiced because the administrative
    findings, conclusions, decisions, or orders are:
    (1)   In violation of constitutional or
    statutory provisions; or
    (2)   In excess of the statutory authority or
    jurisdiction of the agency; or
    (3)   Made upon unlawful procedure; or
    (4)   Affected by other error of law; or
    (5)   Clearly erroneous in view of the reliable,
    probative, and substantial evidence on the
    whole record; or
    (6)   Arbitrary, or capricious, or characterized
    by abuse of discretion or clearly
    unwarranted exercise of discretion.
    Under HRS § 91-14(g), conclusions of law are
    reviewable under subsections (1), (2), and (4);
    questions regarding procedural defects under
    subsection (3); findings of fact under subsection (5);
    and an agency’s exercise of discretion under
    subsection (6).” Sierra Club v. Office of Planning,
    109 Hawai#i 411, 414, 
    126 P.3d 1098
    , 1101 (2006)
    (citation, internal quotation marks and brackets
    omitted).
    Liberty Dialysis-Hawaii, LLC v. Rainbow Dialysis, LLC, 130
    Hawai#i 95, 102-03, 
    306 P.3d 140
    , 147-48 (2013).
    B.     Statutory interpretation
    “‘Statutory interpretation is a question of law
    reviewable de novo.’”• Our construction of statutes is
    guided by the following rules:
    First, the fundamental starting point for
    statutory-interpretation is the language of the
    statute itself. Second, where the statutory
    language is plain and unambiguous, our sole duty
    is to give effect to its plain and obvious
    meaning. Third, implicit in the task of
    statutory construction is our foremost
    obligation to ascertain and give effect to the
    intention of the legislature, which is to be
    obtained primarily from the language contained
    in the statute itself. Fourth, when there is
    doubt, doubleness of meaning, or
    indistinctiveness or uncertainty of an
    expression used in a statute, an ambiguity
    exists.
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    First Ins. Co. of Hawaii v. A&B Props., 126 Hawai#i 406, 414, 
    271 P.3d 1165
    , 1173 (2012) (citations omitted) (quoting State v.
    Wheeler, 121 Hawai#i 383, 390, 
    219 P.3d 1170
    , 1177 (2009)).
    C.     Interpretation of agency rules
    General principles of statutory construction apply in
    interpreting administrative rules. As in statutory
    construction, courts look first at an administrative
    rule’s language. If an administrative rule’s language
    is unambiguous, and its literal application is neither
    inconsistent with the policies of the statute the rule
    implements nor produces an absurd or unjust result,
    courts enforce the rule’s plain meaning. While an
    agency’s interpretation of its own rules is generally
    entitled to deference, this court does not defer to
    agency interpretations that are plainly erroneous or
    inconsistent with the underlying legislative purpose.
    Liberty Dialysis-Hawaii, 130 Hawai#i at 
    103, 306 P.3d at 148
    (internal quotation marks and citations omitted).
    IV.   Discussion
    Under HRS § 88-79, a member of the ERS may qualify for
    service-connected disability retirement benefits if that member
    has been:
    permanently incapacitated for duty as the natural and
    proximate result of an accident occurring while in the
    actual performance of duty at some definite time and
    place, or as the cumulative result of some
    occupational hazard, through no wilful negligence on
    the member’s part[.]
    (Emphasis added); see also HAR § 6-22-8.
    This court has defined “accident” as “an unlooked for
    mishap or untoward event which is not expected or designed.”
    Lopez v. Bd. of Trs., Employees’ Ret. Sys., State of Hawaii, 
    66 Haw. 127
    , 130-31, 
    657 P.2d 1040
    , 1043 (1983).            Notably, unlike
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    workers’ compensation claims, there is no presumption of
    compensability for disability retirement benefits claims.               The
    party initiating the ERS proceeding “shall have the burden of
    proof, including the burden of producing evidence and the burden
    of persuasion. . . . The degree or quantum of proof shall be a
    preponderance of the evidence.”         HAR § 6-23-31 (effective 2009-
    2014).
    Panado argues that (1) the “circuit court erred in too
    narrowly construing ‘definite time and place’” under HRS § 88-79
    when it “concluded that the injuries [Panado] suffered while
    lifting boxes during her October 8-9, 2004 shift did not
    constitute an ‘accident’ because [she] essentially could not
    point to the exact moment during such shift that she was
    injured”; and (2) her October 8-9, 2004 incident is an accident
    under Myers because her case is factually analogous to Myers’.
    She also argues that the “evidence in this case . . .
    demonstrates a causal connection between the October 8-9, 2004
    incident and her incapacity.”
    A.     The ICA should have applied a de novo standard to the issue
    under review, namely, whether the statutory language of
    “definite time and place” requires a claimant to show the
    exact moment when an injury occurs
    The ICA majority and dissent disagreed regarding
    (1) whether the issue under review was a question of law or a
    mixed question of fact; and (2) the standard of review to be
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    applied to the circuit court’s decision.         Accordingly, this court
    will first address these issues.
    The ICA majority concluded the issue under review was a
    mixed question of law and fact regarding “whether the circuit
    court erred by narrowly construing the phrase ‘a definite time
    [and] place’ as used in HRS § 88-79(a) and HAR § 6-22-2 to
    exclude the ‘repetitive lifting and moving of heavy boxes during
    the course of [Panado’s eight-hour] shift[.]’”           (Citing Camara v.
    Agsalud, 
    67 Haw. 212
    , 216, 
    685 P.2d 794
    , 797 (1984)) (brackets in
    the original).    Based on this conclusion, the ICA applied a
    clearly erroneous standard to the circuit court’s decision and
    held that, “the circuit court’s construal of ‘a definite time and
    place’ was not clearly erroneous.”
    The ICA dissent, on the other hand, would have applied
    a de novo standard of review since, in its view, the
    interpretation of “at some definite time and place” was a
    question of law.
    The ICA majority erred in reviewing the circuit court’s
    decision under a clearly erroneous standard.          “Review of a
    decision made by the circuit court upon its review of an
    administrative decision is a secondary appeal.           The circuit
    court’s decision is reviewed de novo.         The agency’s decision is
    reviewed under the standards set forth in HRS § 91-14(g).”
    Liberty Dialysis-Hawaii, 130 Hawai#i at 
    102, 306 P.3d at 147
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    (citations omitted).      As the circuit court was acting as an
    appellate court to the Board of Trustees’ decision, the ICA could
    only apply the HRS § 91-14(g) standards to the Board of Trustees’
    decision in order to determine de novo whether the circuit
    court’s decision was incorrect.10        Instead, the ICA incorrectly
    applied a clearly erroneous standard to the circuit court’s
    decision.
    In addition, the ICA mischaracterized the Board of
    Trustee’s determination upon which this case turns as a mixed
    question of law and fact, to be reviewed under a clearly
    erroneous standard, rather than a question of law, reviewable
    under a de novo standard.11      As a result, the ICA rejected
    10
    Indeed, the circuit court noted that it was not making a mixed
    determination of law and fact, pointing out that “[t]his is a very narrow
    issue regarding the definition of ‘accident[,]’” and concluding as a matter of
    law that Panado’s description of the October 8-9, 2004 incident did not
    satisfy HRS § 88-79’s requirement that the accident occur at “some definite
    time and place[,]”
    11
    The ICA appears to have drawn its understanding of mixed question
    of law and fact from the Board of Trustees, which argued in its reply brief
    that:
    [Panado] has submitted that the only issue presented
    on appeal is a question of law, specifically, whether
    her alleged October 9, 2004 incident occurred at a
    “definite time and place” for purposes of qualifying
    for service-connected disability retirement benefits.
    However, [Panado] is wrong, as this case involves
    mixed questions of fact and law. Only if facts are
    undisputed may a presented question be decided as a
    matter of law.
    (Citations omitted).
    This misapprehends the concept of mixed question of law and fact,
    which is simply an issue that must be determined by applying the law to the
    facts of a case. See Price v. Zoning Bd. of Appeals of City & Cnty. of
    Honolulu, 77 Hawai#i 168, 172, 
    883 P.2d 629
    , 633 (1994) (defining a mixed
    question of law and fact as a “conclusion [that] is dependent upon the facts
    and circumstances of the particular case”).
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    Panado’s contention that the ICA “should apply a de novo standard
    of review to the undisputed fact that the alleged accident
    occurred at her workplace during her eight-hour work shift.”
    However, Panado was correct.        The issue upon which this
    case turns is a question of law, namely, whether the Board of
    Trustees correctly construed HRS § 88-79’s language of “some
    definite time and place.”      More precisely, because the parties
    agreed that Panado was injured during her work shift but that she
    cannot point to a specific moment of injury, the case turns upon
    whether the statutory language of “some definite time and place”
    should be construed broadly to encompass an entire eight-hour
    work period, or narrowly to require that the claimant pinpoint
    the exact moment when an injury occurs.         If “some definite time
    and place” requires proving the precise moment of injury, then
    Panado’s claim fails as a matter of law, whereas if “some
    definite time and place” is construed broadly to simply require
    proof an injury occurred during a specific period of work, then
    Panado’s claim survives with respect to this issue.
    Accordingly, the ICA erred in concluding that the
    circuit court’s decision should be reviewed under a clearly
    erroneous standard and in characterizing the determinative issue
    as a mixed question of law and fact.        Because the determinative
    issue here is whether the statutory language of “definite time
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    and place” requires a claimant to show the exact moment when an
    injury occurs, the appropriate standard of review is de novo.
    Reviewing HRS § 88-79 de novo, the statutory provision
    does not require a claimant to establish the exact moment of
    injury in order to recover service-connected disability
    retirement benefits.     Based on the plain language and legislative
    history of HRS § 88-79, Panado satisfied the provision’s
    requirement of showing that an accident occurred “while in the
    actual performance of duty at some definite time and place” by
    establishing that she was injured during her October 8-9, 2004
    work shift.
    “[T]he fundamental starting point for statutory
    interpretation is the language of the statute itself.”            First
    Ins., 126 Hawai#i at 
    415, 271 P.3d at 1174
    (quoting Wheeler, 121
    Hawai#i at 
    390, 219 P.3d at 1177
    ).        “[W]here the statutory
    language is plain and unambiguous, our sole duty is to give
    effect to its plain and obvious meaning.”         
    Id. The Board
    of
    Trustees maintains that the word “definite” in “definite place
    and time” requires a showing of the “specific time and place” at
    which her injury occurred.
    Contrary to the Board of Trustees’ contention, however,
    the standard definition of “definite” does not require “definite
    time and place” to mean the exact moment of injury.            See Olelo:
    The Corp. for Cmty. Television v. Office of Info. Practices, 116
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    Hawai#i 337, 349, 
    173 P.3d 484
    , 496 (2007) (concluding that in
    the absence of a legislative definition of a term, courts can
    look to legal and lay dictionaries for guidance as to the term’s
    meaning).    “Definite” is commonly defined as, “clearly stated or
    decided; not vague or doubtful.”        The New Oxford Dictionary 447
    (2001).   Here, the parties stipulated to the fact that Panado was
    injured during her work shift on October 8-9, 2004.            The time and
    place of injury is neither vague nor doubtful in this case.
    The Board of Trustees also argues that interpreting HRS
    § 88-79 to permit recovery when Panado cannot point to the
    specific moment of injury would render the “definite time and
    place” language “superfluous, void, or insignificant.”            See
    Beneficial Hawaii, Inc. v. Kida, 96 Hawai#i 289, 309, 
    30 P.3d 895
    , 915 (2001) (“[C]ourts are bound to give effect to all parts
    of a statute, and that no clause, sentence, or word shall be
    construed as superfluous, void, or insignificant.” (Citations
    omitted)).   This contention is without merit.         Rejecting the
    Board of Trustees’ overly narrow interpretation of “definite time
    and place” does not mean jettisoning the “definite time and
    place” requirement.     Instead, Panado satisfied the “some definite
    time and place” requirement by establishing that she was injured
    during her October 8-9, 2004 work shift.
    Accordingly, based on the commonly accepted meaning of
    “definite,” a showing that the injury occurred during Panado’s
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    October 8-9, 2004 work shift does satisfy HRS § 88-79’s “some
    definite time and place” requirement.12
    Even assuming the statutory provision is ambiguous, the
    legislative history does not indicate the legislature intended
    “definite time and place” to restrict disability benefits to
    those who could show the specific moment of injury.            First Ins.,
    126 Hawai#i at 
    415, 271 P.3d at 1174
    (“[w]hen a statute contains
    an ambiguity . . . . courts may resort to extrinsic aids in
    determining legislative intent, such as legislative history”)
    (quoting Wheeler, 121 Hawai#i at 
    390, 219 P.3d at 1177
    ).
    The “some definite time and place” language has been
    part of the provision on accidental disability retirement
    benefits ever since the territorial legislature first established
    Hawaii’s employee retirement system in 1925.          See 1925 Haw. Sess.
    Laws Act 55, § 6(5) at 59-60.       The first accidental disability
    provision stated that:
    Upon application of a member, or of the head of his
    department, any member who has been totally and
    permanently incapacitated for duty as the natural and
    proximate result of an accident occurring while in the
    actual performance of duty at some definite time and
    place, through no negligence on his part, shall be
    retired by the board of trustees, provided that the
    medical board shall certify that such member is
    mentally or physically incapacitated for the further
    performance of duty, that such incapacity is likely to
    be permanent, and that such member should be retired.
    12
    There could be a line-drawing issue in other cases regarding how
    long a period of time must be before it no longer is “definite.” However, it
    is unnecessary to decide the issue here because in the instant case there is
    no dispute that the injury occurred during a specific and defined period of
    work.
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    Id. The 1925
    Territorial Legislature’s Joint Committee on
    Pensions issued a Special Committee Report that outlined the main
    provisions of the proposed Bill regarding the territorial
    government’s employee retirement system, including the accidental
    disability provision quoted above.           H. Spec. Comm. Rep. No. 7 at
    1 (1925).      The territorial legislature did not appear to address
    the “some definite time and place” language. Instead, the
    territorial legislature was concerned with whether an accident
    occurred during work, not with whether the employee could
    pinpoint the exact moment of injury.           For example, the report
    explained that, “Disability benefits are paid upon permanent
    disability as the result of an accident in the performance of
    duty at any time or upon disability from any cause after the
    employee has had ten or more years of service.”              
    Id. at 7.
       The
    report later discussed the disability benefits provision in more
    detail, stating that, “The plan provides that a distinction shall
    be made in the cases of permanent disability that occur as a
    result of accidents in the performance of duty and those due to
    ordinary causes for which the government is not directly
    responsible.”       
    Id. at 27.
       Likewise, the report noted that, “In
    the case of total and permanent disability due to an accident in
    the performance of duty the committee believed that a pension
    should always be payable regardless of the age or length of
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    service of the member.”      
    Id. As the
    above examples show, every
    reference to the provision on accidental disability benefits did
    not indicate that “some definite time and place” or any other
    part of the provision required a claimant to specify the exact
    moment of injury.    The key question reiterated by the committee
    at several points was whether the accident occurred “in the
    performance of duty.”     The legislative history does not indicate
    the “some definite time and place” language was meant to restrict
    the award of accidental disability retirement benefits to those
    claimants who could show an exact moment of injury.
    The legislature’s subsequent expansion of coverage
    under HRS § 88-79 also counsels against the restrictive
    interpretation adopted by the circuit court.          In 1965, the
    legislature amended the service-connected total disability
    statute to include a second category of recovery for any member
    of the retirement fund “who has been permanently incapacitated
    . . . as the cumulative result of some occupational hazard[.]”
    See 1965 Haw. Sess. Laws Act 225, § 1(a) at 355.           This court has
    subsequently interpreted “occupational hazard” to permit a
    claimant to recover when he or she has been exposed to a danger
    accompanying a particular job “if it is not a risk common to
    employment in general.”      See Komatsu v. Bd. of Trs., Employees’
    Ret. Sys., 
    67 Haw. 485
    , 494, 
    693 P.2d 405
    , 412 (1984) (quoting
    
    Lopez, 66 Haw. at 129
    , 657 P.2d at 1042).         Given the
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    legislature’s decision to expand coverage, it would appear
    contrary to legislative policy to restrict coverage by
    interpreting HRS § 88-79 to categorically preclude claims that do
    not allege the exact moment of injury, even when it is undisputed
    that the injury occurred in the performance of work.
    In addition to the lack of support in the legislative
    history, there are several other reasons for not adopting the
    Board of Trustees’ narrow reading of HRS § 88-79’s “some definite
    time and place” language.      One reason for rejecting the Board of
    Trustees’ interpretation is it unreasonably excludes those
    service-connected disabilities in which symptoms do not manifest
    at the exact moment of the accident.        In fact, the Medical Board
    appeared to read this exclusion into HRS § 88-79, by arguing that
    the provision requires that an accident immediately manifest pain
    to be recoverable.     The Medical Board determined Panado did not
    suffer an “accident” because her pain symptoms manifested the
    next day.   Dr. Chinn, a member of the Medical Board who also
    testified on its behalf, stated that “[a]n accident . . . is not
    something that occurs and then develop[s] symptoms the following
    day.”   Dr. Chinn further testified that “when you have an
    accident you have usually immediate symptoms” and that, the “ERS
    definition of accident is pretty clear.         It’s got to occur at a
    specific date and time and in general, there’s an immediate
    complaint of pain or disability.”         Thus, when asked about whether
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    Panado had suffered an accident, given that she experienced pain
    the following day, Dr. Chinn stated, “No. Especially because her
    pain was described as occurring the following day.”
    The Hearing Officer relied on Dr. Chinn’s testimony in
    finding that Panado’s October 8-9 incident did not constitute an
    accident.    In her Recommended Decision, the Hearing Officer
    concluded that, “[t]he fact that [Panado] reported twice that she
    was not injured until the next day is significant,” then quoted
    Dr. Chinn’s testimony that, “generally when you have an accident
    you have usually immediate symptoms.”         As 
    discussed supra
    , the
    Board of Trustees adopted the Hearing Officer’s Recommended
    Decision.
    However, there is no indication the legislature
    intended to categorically exclude coverage for accidents that do
    not result in immediate symptoms.         Although Dr. Chinn testified
    that the “ERS definition of accident is pretty clear” that there
    must be “an immediate complaint of pain or disability[,]” the
    plain language and legislative history of HRS § 88-79 do not
    include such a requirement.
    The existence of accidents that do not result in
    immediate symptoms calls into question the reasonableness of
    denying benefits when the claimant can point to the exact period
    of work during which an accident occurred, but is unsure of which
    exact act caused his or her incapacitation.          Using a slight
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    variation on the facts in Myers13 as an example:           If in Myers,
    the employee had lifted the coffee maker twice, but the onset of
    the same debilitating condition did not occur until the next day,
    there is no rational explanation why the employee should be
    denied retirement benefits because he could not point to which
    one of the two lifts caused the incapacity.           So long as the
    claimant could establish the incapacity was the proximate and
    natural result of either of the two lifts, the claimant should be
    able to qualify for disability retirement benefits under HRS
    § 88-79.14   To deny benefits in this situation, either because a
    claimant cannot point to which exact incident, or because the
    onset of pain did not occur immediately, would be “unjust and
    unreasonable in its consequences.”         Korean Buddhist Dae Won Sa
    Temple of Hawaii v. Sullivan, 87 Hawai#i 217, 229, 
    953 P.2d 1315
    ,
    1327 (1998).
    13
    Myers is not determinative of whether Panado’s incident is an
    “accident” under HRS § 88-79. Although Myers and the instant case are
    factually similar because both involved claimants who suffered injuries as a
    result of lifting something, Myers is not dispositive because it is
    distinguishable with regard to the key issue here, whether a claimant under
    HRS § 88-79 must prove the specific moment of injury. Whereas Panado
    “acknowledges that she is uncertain as to exactly when on October 8-9, 2004
    her injury occurred,” Myers was able to point to the moment he injured
    himself, when he lifted the coffee pot and heard a snap, see 68 Haw. at 
    95, 704 P.2d at 903
    . Thus, Myers did not provide guidance as to how to interpret
    the “a definite time and place” requirement of HRS § 88-79. Accordingly,
    Myers does not control the instant case.
    14
    In fact, the circuit court recognized that some injuries cannot be
    pinpointed to a specific instance. At the September 14, 2012 hearing, the
    Board of Trustees’ counsel argued that in Myers, “there [was] a physical
    symptom that pinpoints, much like a car accident. If there is a time and
    place where the accident occurs and an impact occurs, people can pretty much
    pinpoint that.” However, the circuit court disagreed, pointing out that “soft
    tissue and low impact” accidents may not develop symptoms until much later.
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    Accordingly, the Board of Trustees erred in concluding
    that Panado did not suffer “an accident occurring while in the
    actual performance of duty at some definite time and place.”
    However, since the circuit court did not address the
    Board of Trustees’ second ground for denying Panado’s
    application, that “[Panado’s] permanent incapacity is not the
    natural and proximate result of the alleged incident[,]” we
    remand with regard to that issue.15
    15
    We also note two observations for the court on remand. First,
    given that the Board of Trustees’ FOF 22 and COL 2 refer to the lack of an
    accident, on remand, the court will have to determine whether our analysis
    affects the validity of those holdings.
    Second, we disagree with the Board of Trustees’ conclusion that,
    “[s]ince [Panado] had returned to work and was able to perform all of the
    duties of her full-time job by the October 24, 2005 date of Dr. Maruyama’s
    IME, [Panado’s] permanent incapacity cannot be said to naturally follow from
    the alleged accident.” A claimant’s return to work does not, in and of
    itself, prove a lack of causation between the accident and the later
    incapacitation. See, e.g., Jewel Tea Co. v. Indus. Comm’n, 
    233 N.E.2d 557
    ,
    559 (Ill. 1968) (stating that “a claimant’s return to work after an accident
    is not determinative of causation between the accident and subsequent
    disability”); Walker v. United Parcel Serv., 
    865 P.2d 1113
    , 1116-17 (Mont.
    1993) (“[workers’ compensation claimant’s] return to work is not relevant to
    the causation issue.”). As a matter of common sense, “the fact that [a
    claimant] returned to his [or her] regular job does not indicate that he [or
    she] was completely well or that he [or she] was experiencing no pain.”
    
    Walker, 865 P.2d at 1116-17
    . Moreover, from a policy perspective, a return to
    work despite continuing pain or injury should not be held against an employee
    in the determination of benefits. Doing so would disincentivize employees
    from going back to work for fear that returning would disqualify them from
    receiving benefits. On remand, the fact that Panado went back to work in the
    time between her October 8-9, 2004 incident and her later permanent
    incapacitation should not be construed as proof that the incapacitation did
    not naturally and proximately result from the October 8-9, 2004 incident.
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    V.   Conclusion
    For the foregoing reasons, the ICA’s judgment is
    vacated, the circuit court’s judgment and “Decision And Order
    Affirming The Final Decision of the Board Of Trustees Of The
    Employees’ Retirement System Of The State Of Hawai#i are vacated.
    The case is remanded to the circuit court for further proceedings
    consistent with this opinion.
    Philip W. Miyoshi                  /s/ Mark E. Recktenwald
    for petitioner
    /s/ Paula A. Nakayama
    Elmira K.L. Tsang
    and Kyle K. Chang                  /s/ Sabrina S. McKenna
    for respondent
    /s/ Richard W. Pollack
    /s/ Jeannette H. Castagnetti
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