See McNulty, 804 A.2d at 1263. Whether a disability results from an "aggravation" of a pre-existing condition or a "recurrence" of a prior injury is a question of fact to be determined by the WCJ. See Reliable Foods, Inc. v. W.C.A.B. (Horrocks), 660 A.2d 162, 166 (Pa. Cmwlth. 1995). Section 416 of the Workers' Compensation Act ("the Act")
Udvari v. Workmen's Compensation Appeal Board (USAir, Inc.), 705 A.2d 1290, 1293 (Pa. 1997). Courts within the Commonwealth have distinguished between the phrase "aggravation of a pre-existing condition," which is used to denote a new work-related injury and "recurrence of a prior injury," which denotes an injury directly related to a prior injury. SKF USA, Inc. v. Workmen's Compensation Appeal Board (Smalls), 728 A.2d 385, 387 (Pa. Cmwlth. 1999) (citing Reliable Foods, Inc. v. Workmen's Compensation Appeal Board (Horrocks), 660 A.2d 162, 166 (Pa. Cmwlth. 1995)). [I]n order to adjudicate the rights of the parties, we frequently must attribute causation of the current disability to one event or the other.
This Court, however, has held that "[t]he final determination . . . is not based upon specific words used by the doctor, but rather upon a careful review of the medical testimony to determine its substance rather than its form." Reliable Foods, Inc. v. Workmen's Comp. Appeal Bd. (Horrocks), 660 A.2d 162, 166-67 (Pa. Cmwlth. 1995). As noted above, the terms "recurrence" and "aggravation" are legal terms of art, thus it was not necessary for Dr. Pantelakis to use the term recurrence to establish that a recurrence did, in fact, occur. The WCJ properly reviewed the substance of the report to determine that Claimant suffered a recurrence of a prior injury.
Whether a disability results from an aggravation of a pre-existing condition or is a recurrence of a prior injury is a question of fact for the WCJ to determine. Reliable Foods, Inc. v. Workmen's Comp. Appeal Bd. (Horrocks), 660 A.2d 162 (Pa. Cmwlth. 1995). Applying these principles here, Claimant sustained an October 2003 left knee injury for which he initially received indemnity benefits, followed by a suspension of benefits based on his return to work.
Id. at 417.In so holding, the Court clarified its previous decisions in Reliable Foods, Inc. v. Workmen's Compensation Appeal Board (Horrocks), 660 A.2d 162 (Pa. Cmwlth. 1995) (the claimant was entitled to receive simultaneous benefits for both partial and total disability from separate work injuries up to the maximum compensation rate because, had it not been for the first injury, the claimant would have been receiving a higher wage when the claimant was subsequently totally disabled), and Trenton China Pottery v. Workers' Compensation Appeal Board (Mensch), 773 A.2d 1265 (Pa. Cmwlth. 2001) (the claimant was allowed to receive simultaneous total disability benefits for two separate work injuries; the court apportioned the liability for benefits between the two insurers). See also Tomlinson v. Workmen's Comp. Appeal Bd. (J. Baker, Inc.), 167 Pa. Commw. 329, 648 A.2d 96 (Pa. Cmwlth. 1994) (there is no proscription on the receipt of simultaneous compensation, if the total compensation does not exceed the statutory maximum).
As we have stated previously, the receipt of concurrent partial and total disability benefits, limited by the maximum allowable rate under the Act, is logically sound due to the fact that, but for the claimant's initial partial disability, he would have been receiving a higher wage at the time of the subsequent total disability. Reliable Foods, Inc. v. Workmen's Compensation Appeal Board (Horrocks), 660 A.2d 162 (Pa.Cmwlth. 1995) (when first injury results in partial disability, it is presumed that claimant is incapable of earning pre-injury wage but potentially capable of returning to work with reduced earning capacity; receipt of concurrent benefits from two different insurers is permissible in successive-injury scenarios where maximum compensation benefit is not exceeded). While Safety acknowledges the above articulated principles from Trenton China, it argues that the Board erred in its application.
However, the court in Westmoreland Regional Hospital modified the awards, holding that in every case, regardless of the number of injuries or awards, wage loss compensation must accurately reflect the claimant's loss of pre-injury earning power. Our prior decision in Reliable Foods, Inc. v. Workmen's Compensation Appeal Board (Horrocks), 660 A.2d 162 (Pa.Cmwlth. 1995), illustrates circumstances under which the limitation in section 322 of the Act, 77 P. S. § 677, (prohibiting simultaneous receipt of compensation from more than one employer in excess of the statutory maximum) is properly applied. In Reliable Foods, the claimant's first injury resulted only in partial disability, which left the claimant capable of returning to the workforce with a reduced earning capacity.
However, although the court in Trenton China Pottery apportioned liability under Section 322, a number of decisions had reached the same result without reference to Section 322, simply holding each employer responsible for the effects of its own workplace injury. See, e.g., Tomlinson v. Workmen's Comp. Appeal Bd. (J. Baker, Inc.), 648 A.2d 96 (Pa.Cmwlth. 1994); Yeager v. Workmen's Comp. Appeal Bd. (Schneider, Inc.), 657 A.2d 1372 (Pa.Cmwlth. 1995); Reliable Foods, Inc. v. Workmen's Comp. Appeal Bd. (Horrocks), 660 A.2d 162 (Pa.Cmwlth. 1995). As the Smith Glass court noted, "The partial disability award for the first injury is intended to make up the difference between pre-injury earning power and post-injury earning power.
Tomlinson is inapposite to the instant case because both of Clawson's injuries were totally disabling — Clawson never received partial disability benefits, which would have had the effect of decreasing his baseline wage-earning power before the subsequent injury. Yeager v. Workmen's Compensation Appeal Board (Schneider, Inc.), 657 A.2d 1372 (Pa.Cmwlth. 1995), Reliable Foods, Inc. v. Workmen's Compensation Appeal Board (Horrocks), 660 A.2d 162 (Pa.Cmwlth. 1995), and Trenton China Pottery AIG Claims Service, Inc. v. Workers' Compensation Appeal Board (Mensch and Public Service Mutual), 773 A.2d 1265 (Pa.Cmwlth. 2001), are similar cases in which the claimants suffered partially disabling injuries and later suffered totally disabling injuries. These cases are equally irrelevant to the present case.
However, if a compensable disability results directly from a prior injury but manifests itself on the occasion of an intervening incident, which does not contribute materially to the disability, then the claimant has suffered a recurrence and the employer at the time of the initial injury is responsible for the payment of benefits. Id. If the sequence of events is not sufficient to establish whether a claimant has suffered an aggravation or a recurrence, unequivocal medical testimony is essential. Reliable Foods, Inc. v. Workmen's Compensation Appeal Board (Horrocks), 660 A.2d 162, 166 (Pa.Cmwlth. 1995); Zinc Corp. of America v. Workmen's Compensation Appeal Board (Byers), 603 A.2d 218, 236 (Pa.Cmwlth. 1992). Here, the Board ruled that the WCJ's opinion was not supported by substantial evidence because it was, "not obvious, based upon the credible testimony of Claimant alone, whether his shoulder dislocations on July 9, 1994 and May 30, 1996 were recurrences or aggravations of his work injury, because the dislocations on those dates were preceded by events which may have caused either recurrences or aggravations of his work injury."