Opinion ID: 3010322
Heading Depth: 2
Heading Rank: 2

Heading: dr. manganiello's testimony

Text: Dr. Manganiello's deposition testimony established that he had been a licensed physician for 15 years, practicing general medicine in a region where coal mining was once the prevalent industry. Approximately 10% of his patients are former coal miners, and he sees those patients primarily for anthracosilicosis and anthracosilicosis-related problems. He is, however, neither board-certified nor boardeligible in cardiology, occupational medicine, pulmonary medicine nor internal medicine. Deposition Transcript, at 7- 9. Dr. Manganiello first began treating Angelo Mancia in 1978, primarily for his underlying pneumoconiosis. He saw him at least three times a year thereafter. Mancia's medications consisted of bronchodilator therapy and respiratory treatments, as well as oxygen therapy as needed. Id. at 13. Dr. Manganiello testified he agreed to sign Mancia's death certificate at the coroner's request. Id. at 14. That death certificate states that the immediate cause of death was cardiopulmonary arrest with underlying causes of anthracosilicosis3 with emphysema. _________________________________________________________________ 3. The statutory definition of pneumoconiosis includes anthracosilicosis. 20 C.F.R. SS 718.201 & 727.202. The statutory definition of pneumoconiosis (i.e. any lung disease that is significantly related to, or substantially aggravated by, dust exposure in coal mine employment) is much broader than the medical definition, which only encompasses lung diseases caused by fibrotic reaction of lung tissue to inhaled dust. Labelle Processing Co. v. Swarrow, 72 F.3d 308, 312 (3d Cir. 1996). 5 Dr. Manganiello was confronted with Dr. Candor's conclusion that Mancia died of a heart attack. Candor based that conclusion partly upon Dr. Manganiello's entry on the death certificate. Manganiello answered as follows: No where (sic) in my death certificate or in my opinions do I feel that I have ever expressed a myocardial infarction as his cause of death. I'm not sure where [Candor] extrapolated that type of information. And I'm not sure from where he draws his conclusion. Mr. Mancia never had any symptoms related to his heart. And again, the reason for me stating that Mr. Mancia died of a cardiopulmonary arrest is because his heart stopped. Why his heart stopped, in my opinion, was because of his underlying lung condition. The patient had difficulty breathing. He had difficulty oxygenating his heart on the basis of his breathing; and his heart stopped; not because his heart developed a clot, or he damaged his heart. He had no symptoms referable to that. And nowhere could I state that he died of a myocardial infarction.4 And I don't believe that anyone could make that statement. So I am not sure where he extrapolated that information. Id. at 20-21. Dr. Manganiello was also asked about Dr. Candor's reliance on an April 11, 1991 note written by Dr. Manganiello. As we discuss below, that note is at the heart of the ALJ's rejection of Dr. Manganiello's medical opinion as to the cause of Mancia's death. In that note, Dr. Manganiello wrote that Mancia had suffered a heart attack which was a direct result of his severe anthracosilicosis with emphysema. When asked about that note, Manganiello stated I believe there was one report that I had made, trying to embellish or trying to explain a cardiopulmonary arrest. And I do believe that that report has been mistaken and misunderstood. I totally negate that _________________________________________________________________ 4. Dr. Manganiello explained that a cardiopulmonary arrest is absolutely not the same as a myocardial infarction. The latter is a heart attack, but the heart does not necessarily stop, and unlike a pulmonary arrest where the heart stops, many patients survive a myocardial infarction. Deposition Testimony, at 26-7. 6 report. I do not refer to that in any of my thoughts or any of my opinions in terms of his cardiopulmonary arrest. And again, I believe his heart stopped on the basis of his underlying lung deterioration, and problems relating to his underlying anthracosilicosis. Id. at 21. On cross-examination, the following exchange occurred in response to a question about Manganiello's treatment of diseases related to pneumoconiosis: Q: Dr., in your testimony this morning, you have talked about treating Mr. Mancia for his pneumoconiosis and related diseases. What are those related diseases? A: The pneumoconiosis basically; the underlying infections and problems that he would incur as a result of his severe lung disease. Recurrent episodes of bronchitis. Problems such as cor pulmonale, or buildup of some right-sided heart failure, on the basis of severe underlying lung disease; and problems of that nature. But all related to his lung disease. Id. at 22. Manganiello admitted that his reports did not mention the presence of cor pulmonale and explained that it was not mentioned because it was basically [an] office concern[ ], which was not necessary to note in a report. Id. at 22-23. You could see that the man had some edema of his legs; some swelling in his abdomen from time to time. He required some diuretic therapy from time to time for the treatment of that problem. Id. at 23. Dr. Manganiello further explained that he didn't think it was necessary to order objective tests to confirm the presence of cor pulmonale because it can be diagnosed clinically, and because there is really no treatment for the condition once it is diagnosed. Id. I really don't feel that it was necessary to do that. I believe that a clinical diagnosis can be just as well treated in the office, without any of those studies. Id. at 23. 7