Court Opinion

ID: 9751641
Source: CourtListenerOpinion
Date Created: 2023-08-28 16:41:37.612678+00
Date Added: 2024-06-11T07:26:53.158217
License: Public Domain

DISSENTING OPINION BY
Judge McGINLEY.
I must respectfully dissent.
I believe the majority is modifying the Supreme Court’s pronouncement with respect to the Employer’s burden on a termination petition. According to the majority, an Employer is no longer required to prove a change in physical condition. An employer may now meet its burden on a termination petition by simply presenting an expert’s opinion that the employee was faking. I submit this is no different than unsubstantiated expert testimony that a claimant’s work injury has resolved and it is insufficient, in and of itself, to establish a change in physical condition.
According to our Supreme Court, expert medical testimony that a work injury has resolved, without showing that a claimant’s physical condition has changed, is insufficient to terminate benefits. Lewis v. Workers’ Compensation Appeal Board (Giles & Ransome, Inc.), 591 Pa. 490, 919 A.2d 922 (2007).1 By the same token, a doctor’s testimony that a claimant is faking, without medical proof that his physical condition has changed, is not sufficient to support a termination of benefits.
Here, the WCJ’s decision to terminate benefits was based on his acceptance of Dr. Senter’s and Dr. Talbot’s belief that Claimant was faking his symptoms. However, Employer failed to establish that Claimant’s actual physical condition changed.
Claimant sustained extensive injuries on October 23, 1995, while he unloaded boxes from Employer’s truck. As he looked up, a box of crowbars fell approximately 2-3 feet striking him in the face and head, breaking his teeth and knocking him to his knees.
On May 8, 1997, Claimant underwent a right-sided retromastoid craniectomy at the University of Pittsburgh Medical Center to relieve severe compression of his eighth cranial nerve.2

1. Claimant’s Claim Petition and Established Work Injury

On May 15, 1998, the WCJ granted Claimant’s claim petition and defined the *1149accepted work injury as “disabling positional vertigo as a result of a vascular compression of his balance and hearing nerves at the eighth cranial nerve” as well as injuries of “cervical disc syndrome or cervical myalgia and tension headaches.” WCJ Decision, May 15,1998, at 12.
On July 1, 1999, Claimant underwent a second decompression of the left eighth cranial nerve in an attempt to alleviate his ongoing complaints of disabling positional vertigo and tinnitus.

2. Employer’s Utilization Review Petition

On January 28, 2000, Employer filed a Utilization Review Petition, and challenged the causation of the second subsequent cranial nerve surgery and the reasonableness and necessity of Claimant’s weekly treatments with a chiropractor. On April 5,1999, Claimant filed a Petition to Review Medical Treatment. The petitions were consolidated and hearings were held before the WCJ from May 1999 through July 2000.
Claimant presented the medical reports of Dr. Billot, Dr. Jannetta, Joseph M. Fur-man, M.D., Joseph A. Wapenski, M.D., Joseph K. Eshelman, D.O, all of whom opined that Claimant’s chronic neck pain, headaches, and disequilibrium and the respective treatments were related to the accident.
Employer presented the medical report of John M. Talbot, M.D. who performed an IME of Claimant and reviewed medical records. Dr. Talbot opined that he could not find any convincing objective findings to indicate Claimant had any disability that could be attributed to the October 28, 1995, accident.3
The WCJ rejected Dr. Talbot’s testimony and accepted the testimony of Claimant’s medical experts. The WCJ granted Claimant’s Petition to Review Medical Treatment, denied Employer’s Utilization Review Petition and directed Employer to continue to pay all reasonable and necessary and causally related medical bills including the chiropractor bills and the bills for the surgery.
3. Employer’s First Termination Petition
Four months later, on June 11, 2001, Employer filed its first Termination Petition based on the opinion of Dr. Vertosick who had opined that Claimant recovered from all of his work injuries.
Claimant presented the deposition of Dr. Eshelman who treated Claimant since March 8, 1999, for his neck pain. Electro-diagnostic testing revealed an injury to the nerve at the right C6 which Dr. Eshelman believed was caused when the box full of crowbars came down on Claimant’s head and face and forced his neck backwards, narrowing his nerve openings. Dr. Eshel-man also noted that Claimant had vestibular testing in January 2000, which caused an increase in his vertigo and marked nausea and vomiting.4
Dr. Wapenski also testified by deposition on behalf of Claimant. Dr. Wapenski treated Claimant for his headaches. Dr. Wapenski noted an asymmetric nystagmus during some of Claimant’s visits which, in laymen’s terms, is a jerking movement of the eyes, on the left lateral gaze. According to Dr. Wapenski, the nystagmus that fluctuated during the course of Claimant’s treatments led him to believe that Claimant had an equilibrium problem.5
*1150On September 18, 2003, the WCJ denied the Termination Petition because no diagnostic tests, such as vestibular testing, had been done since Januarg of 2000, and the WCJ was not persuaded that Claimant had fully recovered from all of his compensable work injuries which included “cervical disc syndrome, or cervical myalgia, tension headache, positional vertigo and/or disequilibrium.” WCJ Decision, September 18, 2003, at 12.
J. Employer’s Second Termination Petition
On August 9, 2004, Employer filed a second Termination Petition which is the basis of this appeal. This time, Employer’s Termination Petition was based on the opinions of Howard Senter, M.D. in addition to Dr. Talbot.
Dr. Senter performed an IME on December 11, 2003, which was limited to a physical examination of Claimant at his office. Despite the WCJ’s explicit concern about the lack of updated diagnostic tests, such as vestibular testing, to confirm whether Claimant’s injuries had resolved, Dr. Senter did not review any recent MRI’s, he did not conduct any diagnostic tests, he did not review any updated diagnostic tests. He merely reviewed the 1996 MRI report which established, in his opinion, a degenerative disc disease which was “normal” for a person of Claimant’s age. Dr. Senter Deposition at 29, 51; R.R. at 144a, 166a.6 With respect to headaches, Dr. Senter explained that Claimant reported that he suffered from migraine headaches which Dr. Senter did not believe were related to the work injury. Dr. Sen-ter believed Claimant tried to “deceive” him because Claimant’s responses to his neurological and mechanical examinations were “inconsistent” and that it was not “medically possible for this person to have this combination of neurologic complaints on the basis of any organic disease.” Dr. Senter Deposition at 21; R.R. at 136a. Without performing or reviewing any diagnostic tests which could have confirmed Claimant’s positional vertigo, Dr. Senter testified that Claimant “had no abnormality that I could detect” and that the abnormalities that Claimant manifested were “abnormalities of clear-cut malingering and faking his exam.” Dr. Senter Deposition at 22; R.R. at 137a.
In contrast, Claimant’s experts performed diagnostic tests which produced objective results that could not be faked. Claimant presented the deposition testimony of Joseph M. Furman, M.D., board-certified in psychiatry and neurology. Dr. Furman performed a battery of vestibular laboratory tests on Claimant on May 16, 2005, including a thermal stimulation test and rotational stimulation test, the results of which were abnormal. Dr. Furman explained that the combination of “reduction of sensitivity on one side as compared to another and [the] motion abnormality ... means the brain is not taking the signals in from the two inner ears and processing them properly.” Deposition of Joseph M. Furman, M.D., July 22, 2005, at 7, 1-14; R.R. at 296a, 301a-303a. Dr. Furman explained that the patient was unable to influence the tests and that “the patient has almost no control whatsoever over the response and certainly can’t reduce the responses on one side compared to the other.” Dr. Furman Deposition at 13-14; R.R. at 302a-303a. Dr. Furman opined that the cause of Claimant’s balance disor*1151der was caused by the 1995 head trauma. Dr. Furman Deposition at 19; R.R. at 308a. On cross exam, Dr. Furman acknowledged that the tests may have false positives, but in his opinion the likelihood that Claimant’s tests resulted in a “false positive” was “very, very low” and “unlikely”. Dr. Furman Deposition at 22; R.R. at 311a.
Claimant also presented the testimony of Mark R. Foster, M.D., board-certified in orthopedic surgery, who treated Claimant as recently as March 15, 2005. At that time, Claimant complained of headaches, migraines, and neck pain. Dr. Foster ordered an MRI of Claimant’s neck on September 23, 2004, which showed “narrowing of the neural foramen at C5-6 and a bulging disk and compression of the left C6 root in the left foramen that couldn’t be excluded.” Deposition of Mark R. Foster, M.D., April 19, 2005, at 12; R.R. at 215a. Claimant also had an EMG on September 24, 2004, which showed a “chronic radiculo-pathy, C5-6 on the right and a left chronic radiculopathy at C6-7.” Id. Dr. Foster believed Claimant’s symptoms were directly related to his accident and he recommended an anterior cervical fusion at C5-6. Dr. Foster Deposition at 15; R.R. at 218a.
On April 27, 2006, the WCJ granted Employer’s Termination Petition.
In Lewis, our Supreme Court held that where there have been prior petitions to modify or terminate benefits, the employer seeking modification or termination of benefits must demonstrate by medical proof a change in physical condition since the last disability determination, overruling King:
In order to terminate beneñts on the theory that a claimant’s disability has reduced or ceased due to an improvement of physical ability, it is first necessary that the employer’s petition be based upon medical proof of a change in the claimant’s physical condition. Only then can the workers’ compensation judge determine whether the change in physical condition has effectuated a change in the claimant’s disability, i.e., the loss of his earning power. Further, by natural extension it is necessary that, where there have been pri- or petitions to modify or terminate benefits, the employer must demonstrate a change in physical condition since the last disability determination. Absent this requirement “a disgruntled employer (or claimant) could repeatedly attack what he considers an erroneous decision of a referee by filing petitions based on the same evidence ad infinitum, in the hope that one referee would finally decide in his favor.” Dillon, 640 A.2d at 389, quoting Banks v. WCAB, 15 Pa.Cmwlth. 373, 327 A.2d 404, 406 (1974).
Lewis, 591 Pa. at 497-498, 919 A.2d at 926.
Contrary to the majority, I believe Dr. Senter’s subjective testimony was insufficient “medical proof’ to establish a “change” in Claimant’s physical condition.
Here, Dr. Senter never testified that Claimant’s physical condition (which included severe compression of the eighth cranial nerves) changed since the last adjudication. Dr. Senter merely concluded, based on inconsistent responses during a physical examination, that Claimant was “malingering” and “faking” his symptoms. I submit this was insufficient to meet Employer’s burden to prove Claimant’s physical condition changed or that he fully recovered from the severe compression of his eighth cranial nerves. Despite the lack of any objective medical evidence that Claimant’s physical condition changed since the last adjudication, the majority has essentially allowed Employer to meet its burden by simply offering Dr. Senter’s opinion that the Claimant was faking his *1152symptoms which I submit is in direct contravention to the Supreme Court’s holding in Lewis.
The WCJ also based his decision, in part, on the testimony of Dr. Talbot who, like Dr. Senter, never testified that Claimant’s physical condition changed from the WCJ’s most recent prior adjudication of disability. In fact, Dr. Talbot did not believe that Claimant’s disequilibrium and cranial nerve surgeries were related to the work injuries, despite the original adjudication that the surgeries were work related. He also based his opinion on the erroneous belief that Dr. Wapenski “did not find any nystagmus” that would “correlate with the complaint of dizziness”7, when, in fact, Dr. Wapenski did find nys-tagmus “on the left lateral gaze.” Dr. Wapenski Deposition at 10, Accordingly, I believe, contrary to the majority, that this case indeed falls squarely under Wagma/n. Because Dr. Talbot did not believe Claimant suffered compression of his eighth cranial nerves (Deposition of Dr. Talbot at 25) and he never testified that Claimant recovered from the accepted work injury, the WCJ erred by relying on this testimony to terminate benefits. Critically the outcome espoused by the majority will invite unending litigation, all that will be required is a physician to opine that claimant was “faking.”
I would reverse.
Judge SMITH-RIBNER and Judge PELLEGRINI join in this dissent.

. Where there have been prior petitions to modify or terminate benefits the employer must demonstrate a change in physical condition since the last disability determination. Absent this requirement a disgruntled employer could repeatedly attack what he considers an erroneous decision of a referee by filing petitions based on the same evidence ad infinitum, in the hope that one referee would finally decide in his favor. Banks v. WCAB, 15 Pa.Cmwlth. 373, 327 A.2d 404, 406 (1974).

. The eighth cranial nerve effects balance and hearing.

.See WCJ Decision, February 14, 2001, F.F. No. 20 at 7-8.

. See WCJ Decision, September 18, 2003, F.F. No. 10 at 5-6.

. See WCJ Decision, September 18, 2003, F.F. *1150No. 11 at 8.

. Again, the 1996 MRI had shown the disc protrusion at C4-C5 and supported the WCJ’s original finding of "cervical disc syndrome” on the Claim Petition.

. Dr. Talbot Deposition at 21.