Opinion ID: 3010322
Heading Depth: 2
Heading Rank: 1

Heading: cor pulmonale

Text: Cor pulmonale is a cardiovascular disease and is defined as: Right ventricular (RV) enlargement secondary to malfunction of the lungs, producing pulmonary artery hypertension that may be due to intrinsic pulmonary disease, an abnormal chest bellows, or a depressed ventilatory drive. The term does not include RV enlargement secondary to left ventricular (LV) failure, congenital heart disease, or acquired valvular heart disease. CP is usually chronic but may be acute and reversible. THE MERCK MANUAL, Cardiovascular Disorders, 16th ed. (1992). The most common cause of cor pulmonale is chronic obstructive pulmonary disease (chronic bronchitis, emphysema). Id. Cor pulmonale has been associated with pneumoconiosis as an end-stage complication. See , e.g., Kusiak, R., Liss, G. M. & Gailitis, M. M., Cor Pulmonale and Pneumoconiosisconiotic Lung Disease: An Investigation Using Hospital Discharge Data, 24(2) Am. J. Ind. Med. 161 (1993) (This study found that cor pulmonale was diagnosed 17 times more frequently than expected among men diagnosed with pneumoconiosis than among other men admitted to the authors' hospital). Thus, given Mancia's undisputed medical history of emphysema and pneumoconiosis, it would not be unusual if he also suffered from cor pulmonale. Part 718 of the applicable regulations specifically refer to the relationship between pneumoconiosis and cor pulmonale. We have previously stated that [t]he report of a physician about a miner's degree of disability. . . may have a great deal of significance even if a report lacks full documentation. The report does not necessarily indicate the information upon which the physician relied. It is often buttressed by deposition testimony. . . . For example, the Director informs us that an x-ray is not normally relevant to the degree of disability. If the physician's report fails to mention an x-ray, therefore, that failing should not normally affect 13 the credibility of the physician's finding of total disability. Director, OWCP, v. Mangifest, 826 F.2d 1318, 1327 (3rd Cir. 1987). Since cor pulmonale is so commonly associated with pneumoconiosis, it is not illogical that a treating physician did not document that condition in a miner suffering from black lung disease. This is especially true since Manganiello testified without contradiction that he couldn't treat that condition. The ALJ made his credibility determination based solely upon a reading of the transcript without the advantages that would come from viewing a witness as he or she testifies, and the Director offered no evidence to rebut Manganiello's testimony that Mancia did suffer from cor pulmonale. Dr. Candor's report does not comment upon the presence or absence of cor pulmonale. The ALJ's conclusion that Manganiello's testimony regarding the presence of cor pulmonale was disingenuous amounts to little more than the ALJ substituting his own medical assessment for that of the treating physician. This record does not support the ALJ's jaundiced view of Manganiello's testimony regarding Mancia's cor pulmonale. The ALJ placed too much reliance upon the treating physician's failure to order diagnostic tests absent some medical evidence that diagnostic tests for cor pulmonale were necessary. The ALJ's analysis compels a treating physician to order diagnostic tests which the physician feels are not needed merely to provide objective tests that will satisfy an ALJ at a possible subsequent administrative hearing.