Opinion ID: 1436
Heading Depth: 1
Heading Rank: 24

Heading: Dr Joseph Renn

Text: Dr. Renn was board certified in internal medicine and in pulmonary disease and was a B-reader of x-rays. (EX 10) Dr. Renn relied on treatment records, pulmonary function tests, arterial blood gas tests, medical reports from Drs. Shockey and Repsher, CT scans and x-ray reports when drafting his independent medical review of the Claimant. (EX 4) From the information contained in the above-mentioned sources, Dr. Renn was able to obtain an understanding of the Claimant's occupational history, the Claimant's history of tobacco use and the Claimant's past medical history. (EX 4) After reviewing the above-mentioned information related to the Claimant's respiratory system, Dr. Renn determined that the Claimant had very mild COPD owing to tobacco smoking as well as a very mild obstructive ventilatory defect. (EX 4). He also determined that pneumoconiosis does not exist. (EX 4) Dr. Renn stated that the Claimant was a sixty-two year-old who ... does not have pneumoconiosis. (EX 4) He concluded that it is with a reasonable degree of medical certainty that none of the above diagnoses were either caused, or contributed to, by his exposure to coal mine dust. It is with a reasonable degree of medical certainty that his very mild COPD is a result of his years of tobacco smoking rather than exposure to coal mine dust. (EX 4) Dr. Renn further concluded that, when considering only his respiratory system, it is with a reasonable degree of medical certainty that he is not totally and permanently impaired to the extent that he would be unable to perform his last known coal mining job as safety inspector and shift foreman or any similar work effort. (EX 4). In a deposition taken on June I, 2006, Dr. Renn stated that his finding, that the Claimant's mild obstructive breathing impairment was not related to coal mine dust, was based on the fact that [the Claimant] had the pattern ... that showed that his obstructive airway disease is a result of tobacco smoking; that being the fact that his FEF 25-75 is disproportionately reduced when compared with his peak expiratory flow rate and his FEV1. That is the pattern of tobacco smoking. It is not the pattern of a person with medical coal workers' pneumoconiosis or coal mine dust-induced obstructive airway disease. Then, in 2002, he had a reduction of his diffusing capacity which was at that time by a percentage mildly reduced, but was normal when it was corrected for the alveolar volume. That, too, is a pattern consistent with tobacco smoking but not consistent with a disease caused by coal workers' pneumoconiosis. [9] (EX 10, pg. 6-7) Further, on cross-examination, when the Claimant's counsel stated, so, you found no medical coal workers' pneumoconiosis present here and you testified that was based on the absence of restriction on the pulmonary function test, Dr. Renn stated that his determination was also based on x-ray evidence and the pattern of the dynamic ventilatory function in that [the Claimant] had obstructive airways disease, which could be consistent with coal workers' pneumoconiosis, but the pattern that he had is consistent with tobacco smoke-induced obstructive airways disease. (EX 10, pg. 50-51) Thus, Dr. Renn attributed all of the Claimant's obstruction to his smoking history. (EX 10, pg. 51) When asked if the Claimant had any coal mine dust-related disease causing him impairment, Dr. Renn said no. (EX 10, pg. 40) Dr. Renn stated that the exercise test in 2005 showed that there was no wasted ventilation and that fitness might be limited by heart disease. (EX 10) He testified that the Claimant's blood gas abnormality was not related to coal mine work as he would have associated diminished breathing reserve. (EX 10) The Claimant exercised to 5.9 mets which was beyond the required exertion level in the mines. (EX 10) The physician attributed the gas exchange abnormality to smoking rather than to mining. (EX 10). The undersigned finds Dr. Renn's opinion, which is based upon treatment records, the Claimant's work, social and medical histories, and other physicians' medical reports, test results, and x-ray reports to be well-documented and well-reasoned.