Opinion
No. 119 C.D. 2014
11-19-2014
Margo Woodson, Petitioner v. Workers' Compensation Appeal Board (School District of Philadelphia), Respondent
BEFORE: HONORABLE BERNARD L. McGINLEY, Judge HONORABLE MARY HANNAH LEAVITT, Judge HONORABLE P. KEVIN BROBSON, Judge
OPINION NOT REPORTED
MEMORANDUM OPINION BY JUDGE LEAVITT
Margo Woodson (Claimant) petitions for review of an adjudication of the Workers' Compensation Appeal Board (Board) granting the termination petition of the School District of Philadelphia (Employer) and denying Claimant's review petition. In doing so, the Board affirmed most of the Workers' Compensation Judge's (WCJ) decision. It did, however, add an Achilles tendon injury to Claimant's work injury. We affirm the Board.
On October 4, 2006, Claimant, a secretary for Employer, suffered a work-related injury when she tripped over an outlet on the floor. Employer accepted liability for the injury and issued a Notice of Compensation Payable (NCP) on October 16, 2006, describing the injury as a right ankle sprain. On November 22, 2006, Claimant underwent an MRI of her right ankle, which revealed a tear of her Achilles tendon. Claimant underwent surgery to repair the tear on December 21, 2006. Her foot was placed in a cast that proved to be too tight, requiring a second cast. When the second cast was removed on February 6, 2007, Claimant experienced pain in her lower right leg.
Claimant received a series of lumbar injections to treat this pain. After the first injection, Claimant began to suffer constant headaches, possibly due to a puncture of the dura. On July 27, 2007, Claimant began to treat with Dr. Daphne Golding, a physiatrist who is not currently board-certified. Claimant underwent an electromyography (EMG) exam, which revealed a right perineal neuropathy with a double crush injury. Dr. Golding referred Claimant to Dr. Cohen, who injected Claimant's occipital nerve to relieve the pain. The headaches relented for a few days but later returned. In an effort to alleviate Claimant's pain, Dr. Golding ordered a new brace for Claimant's ankle as well as a boot. Dr. Golding also prescribed different medications, including Lyrica, Topamax, Etodolac, and Lioderm patches.
Claimant's physician, Daphne Golding, M.D., testified that the dura is a "covering that goes over the area where the spinal cord and the spinal nerves travel. . . . There's a sac there and there's fluid in that sac." Reproduced Record (R.R.) 86a. If the dura is punctured, some of the spinal fluid will leak out, causing a pressure differential and headaches. Dr. Golding opined that Dr. Ratner, the doctor performing the lumbar injections, punctured the dura.
Dr. Golding was board-certified in 1995. Her certification lapsed in 2005. At her deposition on January 22, 2009, she stated that she had not yet reapplied for certification but planned to do so.
On February 4, 2008, Claimant received a blood patch for her headaches. It did not resolve Claimant's headaches, so she received a second patch on March 11, 2008, which resolved the headaches. However, she continued to suffer pain in the back of her head. Claimant testified that the pain intensifies when she lies down and she has not slept well since the headaches began.
A blood patch is a substance injected into the dura to seal the hole caused by a dural puncture. Once the puncture is sealed, the pressure differential will resolve and the headaches will cease.
On May 6, 2008, Claimant filed a review petition seeking to amend the NCP to include additional injuries. Specifically, Claimant sought to include right-side complex regional pain syndrome of the lower extremity, post-dural puncture headaches, an Achilles tendon tear, and lower back pain. On October 15, 2008, Employer filed a termination petition alleging that Claimant had fully recovered from her work-related injuries as of October 10, 2008. The petitions were assigned to a WCJ, and the parties proceeded to a hearing.
Initially, Claimant's counsel stated that the injury was Achilles tendonitis. R.R. 25a. Later, counsel clarified that the amendment was sought to include a tear of the Achilles tendon, not tendonitis. R.R. 137a.
Dr. Golding testified on behalf of Claimant. Dr. Golding recalled that during her first examination of Claimant on July 27, 2007, she observed limited mobility, decreased sensation between the first and second toe, weakness in the ankle muscles, slightly grayish skin, skin sensitivity, and a painful, limping gait. Based on Claimant's history and complaints of pain, Dr. Golding diagnosed Claimant with complex regional pain syndrome as well as right perineal neuropathy. Dr. Golding testified that three of Claimant's other treating doctors, Dr. Bala, Dr. Burke, and Dr. Ratner, had also diagnosed Claimant with complex regional pain syndrome. Dr. Golding concluded that Claimant's complex regional pain syndrome, Achilles tendon tear, perineal injury, back pain, and headaches were all related to Claimant's work injury. Additionally, Dr. Golding opined that Claimant's complex regional pain syndrome was not resolved and, therefore, Claimant was unable to return to work. Dr. Golding admitted on cross- examination that she did not record abnormal hair or nail growth, muscle atrophy, or ongoing skin discoloration, which are symptoms of complex regional pain syndrome.
Employer presented the testimony of Dr. Wilhelmina Korevaar, who is a board certified anesthesiologist with a sub-specialty in pain management. Dr. Korevaar did two independent medical examinations (IME) of Claimant on March 14, 2008, and October 10, 2008. Dr. Korevaar took a medical history and reviewed Claimant's medical records. She noted that Claimant had continued the lumbar injections even though the provider, Dr. Ratner, acknowledged that he might have punctured Claimant's dura. Upon examination, Dr. Korevaar observed that Claimant demonstrated voluntary full rotation of her ankle; full extension of the leg; inversion, eversion, dorsi and plantar flexion of the ankle; and flexion and extension of her toes. Dr. Korevaar noted no localized tenderness, hypersensitivity, or atrophy.
Dr. Korevaar testified that she saw no evidence that Claimant had received a blood patch, such as a needle puncture or bruising, even though the second procedure had been performed three days prior to Claimant's first IME.
Dr. Korevaar opined that Claimant may have suffered a right ankle sprain or Achilles tendon tear, but did not suffer from complex regional pain syndrome as a result of her work injury. Dr. Korevaar stated that she saw no objective evidence of complex regional pain syndrome, such as dystrophic skin changes, swelling, calluses, or skin or nail abnormalities. Dr. Korevaar did observe redness in Claimant's leg, which she attributed to Claimant's ankle brace being too tight. Dr. Korevaar concluded that Claimant's headaches were not work-related because the symptoms were atypical for complex regional pain syndrome. Dr. Korevaar explained that Claimant's headaches should not have intensified when she lay down and should have resolved after a period of time regardless of the blood patches. Additionally, Dr. Korevaar opined that Claimant's low back pain and thigh numbness were not work-related injuries because their onset was too recent. Dr. Korevaar opined that Claimant had fully recovered from her work injury and was able to return to work. On cross-examination, Dr. Korevaar admitted that "it would be difficult" to argue that the surgery to repair Claimant's Achilles tendon was not work related. R.R. 55a.
Dr. Korevaar disagreed with Dr. Golding's prescription of several drugs and noted that Dr. Golding had increased the dosage even though there was no indication that the medications were effective. Specifically, Dr. Korevaar opined that Lyrica and Topamax were not reasonably related to the work injury because there were no studies indicating the drugs were effective in treating complex regional pain syndrome and those medications had side effects, such as drowsiness.
The WCJ granted Employer's termination petition and denied Claimant's review petition. Claimant appealed and the Board affirmed in part and reversed in part. The Board affirmed the WCJ's grant of Employer's termination petition. The Board also affirmed the denial of Claimant's review petition, except with respect to Claimant's right Achilles tendon tear, which the Board held should be added to the NCP. Claimant now petitions for this Court's review.
Our review is limited to determining whether necessary findings of fact are supported by substantial evidence, whether the Board's procedures were violated, whether constitutional rights were violated, or whether an error of law was committed. Section 704 of the Administrative Agency Law, 2 Pa. C.S. §704; Graves v. Workers' Compensation Appeal Board (Philadelphia Housing Authority), 983 A.2d 241, 244 n.6 (Pa. Cmwlth. 2009).
Claimant argues on appeal that the Board erred in affirming the WCJ's grant of Employer's termination petition because that decision was not supported by substantial evidence. Employer counters that Claimant is asking this Court to overturn the WCJ's credibility determinations, which is beyond our scope of review.
A claimant who seeks to modify an NCP by filing a review petition bears the burden of proving that another injury should be recognized as work-related. Harrison v. Workers' Compensation Appeal Board (Auto Truck Transport Corp.), 78 A.3d 699, 703 (Pa. Cmwlth. 2013). "The party seeking to amend the NCP has the burden of proving that the NCP is materially incorrect." Id. The employer has the burden of proof on a termination petition. Seilhamer v. Workmen's Compensation Appeal Board (Berwind Railway Service Co.), 552 A.2d 336, 337 (Pa. Cmwlth. 1988). The employer must establish by substantial evidence that the disability has ceased or been reduced and that the employee is able to return to work. Id.
Substantial evidence is such relevant evidence that a reasonable person might find sufficient to support the WCJ's findings. Rosenberg v. Workers' Compensation Appeal Board (Pike County), 942 A.2d 245, 249 n.4 (Pa. Cmwlth. 2008). The ultimate fact finder is the WCJ. Magayna v. Workmen's Compensation Appeal Board (Jones & Laughlin Steel Corp.), 539 A.2d 952, 954 (Pa. Cmwlth. 1988). The WCJ is free to accept, in whole or in part, the testimony of any witness, including medical witnesses. Greenwich Collieries v. Workmen's Compensation Appeal Board (Buck), 664 A.2d 703, 706 (Pa. Cmwlth. 1995). The WCJ is required to issue a reasoned decision which "allows for adequate review by the [Board] without further elucidation and . . . allows for adequate review by the appellate courts under applicable review standards." Daniels v. Workers' Compensation Appeal Board (Tristate Transport), 828 A.2d 1043, 1052 (Pa. 2003).
Claimant argues that the WCJ's opinion is "patently erroneous" and "fraught with gross mischaracterizations of the evidence and evinces [the WCJ's] utter lack of understanding of the chain of events which unfolded in [Claimant's] case." Claimant's Brief at 12. Specifically, Claimant notes that Employer's claims adjuster recommended that Claimant undergo the lumbar injections, and it was during those procedures that her dura was punctured. The dural puncture caused headaches and complex regional pain syndrome, which required blood patches that cured Claimant's global headaches but not her occipital headaches. Claimant contends that this chain of events establishes that all of the injuries are work-related. Claimant also contends that Dr. Korevaar's testimony was not credible and that the WCJ improperly discredited Dr. Golding's testimony. Therefore, Claimant concludes that the WCJ's decision is not supported by substantial evidence. We reject her argument.
The WCJ found Dr. Golding not credible for several reasons. First, she was not board certified. Second, she relied entirely on Claimant's own subjective complaints. Third, two other doctors' reports stated that Claimant was capable of heel/toe walking without signs of pain, had full range of motion and showed no sign of sensory discomfort, which was contrary to Dr. Golding's testimony and opinion. Furthermore, the WCJ noted that there were no objective symptoms or signs of complex regional pain syndrome apart from a brief time when Claimant's skin had a grayish hue, which disappeared. Instead, the WCJ found Dr. Korevaar credible based on her qualifications and reliance on objective evidence to support her conclusions. The WCJ also rejected Claimant's testimony as not credible.
We conclude that the WCJ issued a reasoned decision that is fully supported by substantial evidence. Dr. Golding and Dr. Korevaar presented divergent viewpoints regarding whether Claimant suffered from complex regional pain syndrome and whether her injuries, other than the Achilles tendon injury, were work-related. Ultimately, the WCJ credited Dr. Korevaar's opinion because Claimant exhibited no objective signs of complex regional pain syndrome and not all of Claimant's symptoms that developed after the lumbar injections could be causally connected to the work incident. Additional medical evidence from other physicians showed that Claimant suffered no sensory discomfort, enjoyed full range of motion, and was able to walk without pain.
Similarly, the WCJ's determination that Claimant's lower back pain was not work-related is supported by substantial evidence. Specifically, the WCJ found that Claimant suffered from a degenerative condition. Because Claimant exhibited no tenderness or spasm on palpation, normal lumbar results, and full range of motion, the WCJ also found that Claimant did not suffer from complex regional pain syndrome. These findings are consonant with the evidence of record.
The WCJ could have found Dr. Golding's opinion and testimony credible, but he chose to accept Dr. Korevaar's testimony. As noted, this Court may not alter the credibility determinations of the WCJ if the decision is supported by substantial evidence. Greenwich Collieries, 664 A.2d at 706 ("Where there is substantial, competent evidence in the record to support the [WCJ's] findings, the reasons for a [WCJ's] credibility determinations become superfluous because this court does not have the authority to review credibility determinations."). Here, the WCJ's decision is supported by substantial evidence, and we so hold.
We agree with the Board, however, that Claimant proved that her Achilles tendon injury was work-related since Dr. Korevaar's credited testimony supported that finding. Therefore, the Board correctly reversed in part the WCJ's decision and granted Claimant's review petition regarding the Achilles tendon tear.
Because we find that the WCJ's decision was supported by substantial evidence, we need not address Claimant's additional arguments regarding the credibility determinations made by the WCJ. --------
For these reasons, we affirm the Board's order.
/s/_________
MARY HANNAH LEAVITT, Judge ORDER
AND NOW, this 19th day of November, 2014, the order of the Workers' Compensation Appeal Board, dated December 23, 2013, is hereby AFFIRMED.
/s/_________
MARY HANNAH LEAVITT, Judge