Opinion ID: 1272947
Heading Depth: 1
Heading Rank: 3

Heading: Medical Issue

Text: Claimant was examined by the O.P. Board on April 21, 1998. Claimant demonstrated mild wheezing throughout all of both lung fields at the time of his examination. The wheezing persisted after exercise. The O.P. Board made no diagnosis of occupational pneumoconiosis. The O.P. Board diagnosed non-occupational subpleural fat bilaterally. [4] Claimant gave a history of shortness of breath for ten years, and a history of smoking for 37 years, quitting five years earlier. Based upon its physical examination, claimant's history, claimant's pulmonary function testing and its review of claimant's radiographic testing, the O.P. Board concluded that claimant did not suffer from occupational pneumoconiosis and that he had no pulmonary impairment attributed to his occupation. Based upon the conclusions and recommendations of the O.P. Board, the Commission issued an order, dated June 18, 1998, which granted no award for occupational pneumoconiosis. Claimant protested this medical order. In support of his protest, claimant introduced re-reads of the O.P. Board's x-rays by Dominic Gaziano, M.D. (hereinafter Dr. Gaziano), and by Edward Aycoth, M.D. (hereinafter Dr. Aycoth). Dr. Gaziano found the O.P. Board's x-rays to be of grade 1 quality. He read the x-rays as showing parenchymal abnormalities consistent with pneumoconiosis consisting of q/t opacities in all six lung zones in a profusion of 1/0. He found no pleural abnormalities. Dr. Aycoth found the O.P. Board's x-rays to be of grade 1 quality. He read the x-rays as showing scattered rounded p/p opacities measuring up to 1.5 millimeters in diameter in all six lung zones in a profusion of 1/0. Dr. Aycoth also diagnosed diffuse Grade A pleural thickening along the right and left lateral chest walls measuring up to 5 millimeters in width. He made no mention of subpleural fat. The employer introduced re-reads of both the Parkersburg Radiology Services chest x-ray and the O.P. Board chest x-rays. John Willis, M.D. (hereinafter Dr. Willis), classified both sets of films as grade 2, with slight over-exposure. Dr. Willis concluded that there was insufficient parenchymal abnormalities to suggest pneumoconiosis. He also diagnosed subpleural fat bilaterally, with no pleural plaques and no pleural thickening identified. James T. Smith, M.D., (hereinafter Dr. Smith) classified both films as grade 1. As with Dr. Willis, Dr. Smith made no diagnosis of pneumoconiosis. He also diagnosed bilateral, symmetrical subpleural fat with no pleural abnormalities suggestive of an occupational lung disease. David A. Sparks, M.D. (hereinafter Dr. Sparks) classified the O.P. Board's films as grade 2, with overexposure, and the Parkersburg Radiology Services films as grade 1. Dr. Sparks concluded that a diagnosis of occupational pneumoconiosis could not be made based upon the chest x-rays reviewed. He also diagnosed a mild amount of subpleural fact bilaterally, with no other pleural or parenchymal abnormalities. The O.P. Board gave testimony on the medical issue at a final hearing held on November 10, 2004. Testimony was first taken of the O.P. Board's radiologist, Johnsey L. Leef, Jr., M.D. (hereinafter Dr. Leef). [5] Dr. Leef posted all chest x-ray films at issue on an x-ray view box and made reference to the films while testifying. He specifically was asked to physically look for the changes allegedly observed by Drs. Aycoth, Bassali and Gaziano on the films. In making specific reference to the films, Dr. Leef concluded that the alleged changes referenced were physically not present. He also noted that Drs. Aycoth, Bassali and Gaziano did not have the benefit of reviewing all of the chest x-rays of record, but that Drs. Willis, Sparks and Smith, as well as he, himself, had the opportunity to view both sets of x-rays. Dr. Leef testified that it is good practice to review as many x-rays as possible in considering a diagnosis. Having reviewed the reports of Drs. Aycoth, Bassali and Gaziano against the actual chest x-ray films of record, Dr. Leef made a finding of medical fact to the effect that the conclusions of Drs. Willis, Sparks and Smith were reliable, and the conclusions of Drs. Aycoth, Bassali and Gaziano were unreliable based upon the finding that the alleged changes noted in their reports as supporting their purported diagnoses were physically not present on the films. Testimony was also obtained from James H. Walker, M.D. (hereinafter Dr. Walker), Chairman of the O.P. Board, and Jack L. Kinder, Jr., M.D. (hereinafter Dr. Kinder), member of the O.P. Board. Neither physician member of the O.P. Board diagnosed occupational pneumoconiosis and both agreed with the conclusions of Dr. Leef. Furthermore, both Dr. Walker and Dr. Kinder concluded that, to a reasonable degree of medical certainty, claimant had no pulmonary impairment attributable to an occupational factor. Dr. Walker specifically identified claimant's wheezing as being consistent with non-occupational bronchospastic disease. He attributed this wheezing to claimant's 37-year tobacco usage. Dr. Kinder agreed with Dr. Walker's conclusions. By order of December 15, 2004, the OOJ affirmed the Commission's June 18, 1998, order, which granted no award for occupational pneumoconiosis to claimant. In this order, Judge Haslebacher thoroughly reviewed all evidence of record on the medical issue. Based upon the findings of the O.P. Board and the lack of objective correlation at hearing for the purported diagnoses of Drs. Bassali, Aycoth and Gaziano, the conclusions of such physicians were found to be incorrect and unreliable. Judge Haslebacher further noted the mutual inconsistencies present when the conclusions of Drs. Bassali, Aycoth and Gaziano were compared. He observed that one could only wonder if these physicians were looking at the same individual. Judge Haslebacher further noted that the reports of Drs. Sparks, Smith and Willis were consistent not only with each other, but also with the findings of the O.P. Board. Claimant appealed this order to the BOR. By order of May 30, 2006, the BOR reversed the December 15, 2004, order of the OOJ, and granted claimant a 5% award for the diagnosis of occupational pneumoconiosis with no pulmonary impairment. [6] In its order, the BOR concluded that the analysis and conclusions of the OOJ were clearly wrong in view of the reliable, probative and substantial evidence of record. In so doing, the BOR stated that the OOJ had no substantiation for its conclusion that the conclusions of Drs. Bassali, Aycoth and Gaziano were unreliable. Judge Rita Hedrick-Helmick (hereinafter Judge Hedrick-Helmick) dissented to the reversal of the December 15, 2004, OOJ order, and the granting of a 5% permanent partial disability award. Citing West Virginia Code, § 23-4-6a, Judge Hedrick-Helmick concluded that nothing in the record showed the O.P. Board or the OOJ to be clearly wrong.