Court Opinion

ID: 9948094
Source: CourtListenerOpinion
Date Created: 2024-03-06 15:11:47.461905+00
Date Added: 2024-06-11T14:29:05.266660
License: Public Domain

IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Kathryn A. Lawry,                        :
                    Petitioner           :
                                         :
            v.                           :
                                         :
County of Butler (Workers’               :
Compensation Appeal Board),              :   No. 593 C.D. 2022
                  Respondent             :   Argued: February 6, 2024

BEFORE:     HONORABLE RENÉE COHN JUBELIRER, President Judge
            HONORABLE ANNE E. COVEY, Judge
            HONORABLE MARY HANNAH LEAVITT, Senior Judge

OPINION BY
JUDGE COVEY                                         FILED: March 6, 2024

            Kathryn A. Lawry (Claimant) petitions this Court for review of the
Workers’ Compensation (WC) Appeal Board’s (Board) May 17, 2022 order
reversing WC Judge (WCJ) Robert Steiner’s (WCJ Steiner) decision that denied the
County of Butler’s (Employer) Petition to Terminate WC benefits (Termination
Petition). Claimant presents one issue for this Court’s review: whether the Board’s
decision violated long-standing and fundamental WC principles, and, therefore,
should be reversed. After review, this Court reverses.
            On June 24, 2009, Claimant suffered a work-related injury which
Employer accepted as a right thumb strain/sprain. On July 26, 2011, WCJ Steiner
expanded the injury description to include right ulnar collateral ligament tear and
reflex sympathetic dystrophy (RSD)/complex regional pain syndrome (CRPS).
Relevant to the instant appeal, on February 13, 2019, WCJ Steiner denied
Employer’s prior Termination Petition, which alleged a full recovery date as of
March 27, 2018.1 In denying the prior Termination Petition, WCJ Steiner rejected
Steven Thomas M.D.’s (Dr. Thomas) opinion that as of March 27, 2018, Claimant
had no objective or physical findings on examination to support the continuing
RSD/CRPS diagnosis and that Claimant’s pain complaints were from malingering.
Instead, WCJ Steiner found that Employer failed to prove that Claimant’s physical
condition had changed since a prior June 24, 2015 decision. WCJ Steiner found
David A. Provenzano, M.D. (Dr. Provenzano) and Ashraf Razzak, M.D. (Dr.
Razzak) to be credible that Claimant continued to have physical signs and symptoms
of RSD/CRPS, and accepted Dr. Provenzano’s assessment that Claimant had CRPS
I of the right upper limb with pain in the right hand, and that she met the Budapest
criteria for CRPS of the right hand as a result of his March 23, 2018 examination.
WCJ Steiner further noted that, from his own personal observation of Claimant at
the hearing, Claimant had some swelling and redness with skin mottling, with little
to no hair on the back of Claimant’s right hand.
              On July 7, 2020, Employer filed the instant Termination Petition
alleging that Claimant fully recovered from her June 24, 2009 work injury as of June
17, 2020. WCJ Steiner held hearings on August 5 and September 18, 2020, and
January 20 and March 16, 2021. On July 1, 2021, WCJ Steiner denied Employer’s
Termination Petition.2 WCJ Steiner ruled that Employer met its burden of proving
that Claimant fully recovered from her right thumb strain/sprain and right ulnar
collateral ligament tear. However, WCJ Steiner determined that Employer failed to
meet its burden of proving that Claimant fully recovered from her RSD/CRPS. WCJ

       1
          Employer filed four Termination Petitions. The first Termination Petition sought relief
as of April 23, 2010, which WCJ Steiner denied on July 26, 2011. The second Termination Petition
sought relief as of May 27, 2013, which WCJ Alfred Benedict denied on June 24, 2015. The third
Termination Petition sought relief as of March 27, 2018, which WCJ Steiner denied on February
13, 2019. The instant fourth Termination Petition sought relief as of June 17, 2020, which WCJ
Steiner denied on July 1, 2021.
        2
          Claimant appeared pro se before WCJ Steiner.
                                               2
Steiner explained that in Kesselring v. Workers’ Compensation Appeal Board
(Pocono Medical Center and Qual-Lynx) (Pa. Cmwlth. No. 1786 C.D. 2019, filed
Jan. 22, 2021), this Court stated that the gold standard for diagnosing RSD or CRPS
is the Budapest criteria, and Robert Goitz, M.D. (Dr. Goitz) gave his opinion without
specifically addressing it, and without any evidence of any recent objective
diagnostic tests to determine whether Claimant had continuing RSD/CRPS.3
Employer appealed to the Board which reversed WCJ Steiner’s decision denying the
Termination Petition.4 The Board explained that WCJ Steiner’s determination that
Dr. Goitz’s testimony, that Claimant fully recovered from RSD/CRPS, was not
credible, based on Dr. Goitz’s failure to reference the Budapest criteria, and was
arbitrary and capricious. Claimant appealed to this Court.5
               Initially, the Pennsylvania Supreme Court has instructed:

               In order to terminate benefits 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 [WCJ] 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 prior petitions to modify or terminate benefits, the
               employer must demonstrate a change in physical
               condition since the last disability determination.

       3
         However, the Kesselring Court merely stated that “Dr. Ruht’s assessment was based on
the Budapest criteria, which he claimed is the gold standard in the industry for diagnosing RSD or
CRPS.” Id., slip op. at 16 n.15. It did not outline the Budapest criteria and/or discuss its
importance to RSD/CRPS.
       4
         Claimant acted pro se before the Board.
       5
         “Our standard of review of a Board order limits us to determining whether the necessary
findings of fact are supported by substantial evidence, whether an error of law or a violation of
Board procedure has occurred, or whether constitutional rights were violated.” Essix Holdings,
LLC v. Dengel (Workers’ Comp. Appeal Bd.), 276 A.3d 830, 833-34 (Pa. Cmwlth. 2022).

                                                3
Lewis v. Workers’ Comp. Appeal Bd. (Giles & Ransome, Inc.), 919 A.2d 922, 926
(Pa. 2007) (emphasis added).

             “The determination of whether a claimant’s subjective
             complaints of pain are accepted is a question of fact for the
             WCJ.” Udvari [v. Workmen’s Comp. Appeal Bd. (USAir,
             Inc.)], 705 A.2d [1290,] 1293 [(Pa. 1997)]. Moreover, it
             is well established that “[t]he WCJ is the ultimate fact[-
             ]finder and has exclusive province over questions of
             credibility and evidentiary weight.” Univ. of Pa. v.
             Workers’ Comp. Appeal Bd. (Hicks), 16 A.3d 1225, 1229
             n.8 (Pa. Cmwlth. 2011). “The WCJ, therefore, is free to
             accept or reject, in whole or in part, the testimony of
             any witness, including medical witnesses.” Griffiths v.
             Workers’ Comp. Appeal Bd. (Red Lobster), 760 A.2d 72,
             76 (Pa. Cmwlth. 2000).

Baumann v. Workers’ Comp. Appeal Bd. (Kellogg Co.), 147 A.3d 1283, 1290 (Pa.
Cmwlth. 2016) (emphasis added).
             Claimant argues that the Board violated long-standing and fundamental
WC principles by overturning WCJ Steiner’s credibility determination of Dr. Goitz.
Claimant further contends that in order to satisfy Lewis, Dr. Goitz was required to
look to the Budapest criteria, address each of its components, and state what
component or components had changed. Claimant asserts that because Dr. Goitz did
not do that, Employer did not satisfy Lewis. Employer rejoins that WCJ Steiner
erred by rejecting Dr. Goitz’s full recovery opinion relative to RSD/CRPS based on
the fact that Dr. Goitz had not assessed Claimant using the Budapest criteria.
             This Court has explained:

             While many cases since Daniels [v. Workers’
             Compensation Appeal Board (Tristate Transport), 828
             A.2d 1043 (Pa. 2003),] have addressed the adequacy of the
             reasons set out by the WCJ in support of his or her
             credibility determination, we have not clearly addressed
             the standard by which we review such reasoning.

                                          4
               While many petitioners challenging an adverse credibility
               determination would suggest that we review each and
               every component of the WCJ’s reasoning for substantial
               evidence and reverse or remand if we can find any flaw,
               we do not believe the reasoned decision requirement takes
               us so far from the traditional notions of the deference owed
               credibility determinations. Indeed, the Daniels [C]ourt
               cited with approval this [C]ourt’s opinion in PEC
               Contracting Engineers v. Workers[’] Comp[ensation]
               Appeal [Board] (Hutchison), 717 A.2d 1086 (Pa. Cmwlth.
               1998), which stated:
                   The requirement that the WCJ adequately explain
                   his reasons for accepting or rejecting evidence
                   protects the parties to a decision by ensuring that a
                   legally erroneous basis for a finding will not lie
                   undiscovered. For instance, if a WCJ rejects
                   evidence based on an erroneous conclusion that
                   testimony is equivocal, or that the evidence is
                   hearsay or for some other reason incompetent,
                   such legal error will be evident and can be
                   corrected on appeal.
                   However, the WCJ’s prerogative to determine
                   the credibility of witnesses and the weight to be
                   accorded evidence has not been diminished by
                   the amendments to Section 422(a) [of the WC
                   Act].[6] Such determinations are binding on
                   appeal      unless     made      arbitrarily     and
                   capriciously. Ryan v. Workers[’] Comp[.] Appeal
                   [Bd.] ([Cmty.] Health [Servs.]), . . . 707 A.2d 1130
                   ([Pa.] 1998).
               PEC Contr[acting] Engs., 717 A.2d at 1088-89.

Casne v. Workers’ Comp. Appeal Bd. (STAT Couriers, Inc.), 962 A.2d 14, 18-19
(Pa. Cmwlth. 2008) (emphasis added).
               Here the Board opined: “WCJ [Steiner] capriciously disregarded
competent medical evidence in rendering his finding that [Employer] had not met its

      6
          Act of June 2, 1915, P.L. 736, as amended, 77 P.S. § 834.

                                                5
burden of proving its entitlement to a termination of [WC] benefits as of June 17,
2020.” Reproduced Record (R.R.) at 295a. The Board explained:

            WCJ [Steiner] credited Dr. Goitz’s opinion as to
            Claimant’s full recovery from her right thumb
            sprain/strain and ulnar collateral ligament tear. However,
            [] WCJ [Steiner] rejected Dr. Goitz’s opinion as not
            credible concerning Claimant’s full recovery from her
            work-related RSD/CRPS diagnosis. In so doing, []
            WCJ [Steiner] relied upon the “Budapest [c]riteria”
            used by Dr. Ruht in Kesselring, wherein Dr. Ruht
            determined that the employee did not meet the criteria for
            an RSD/CRPS diagnosis. In a footnote to the opinion, the
            [Kesselring C]ourt noted that “Dr. Ruht’s assessment was
            based on the Budapest [c]riteria, which he claimed is the
            gold standard in the industry for diagnosing RSD or
            CRPS.” Kesselring[, slip op.] at 8. Other than this limited
            reference to the Budapest [c]riteria in this footnote, the
            [Kesselring C]ourt did not outline the Budapest [c]riteria
            and/or discuss its importance to RSD/CRPS. It is unclear
            from this reference whether the Budapest [c]riteria are
            useful only in diagnosing RSD/CRPS, or whether they are
            also used in a determination of full recovery from the
            same.       Moreover, it is unclear what level of
            standardization the Budapest [c]riteria have reached, if
            any, among the medical community concerning
            RSD/CRPS diagnoses and recovery determinations. Thus,
            [the Board] determine[s] that it was erroneous for []
            WCJ [Steiner] to adopt another doctor’s medical
            opinion, that of Dr. Ruht, for application to the instant
            matter. Dr. Ruht was not involved in Claimant’s
            treatment of RSD/CRPS, nor is he otherwise involved in
            this case. While Dr. Ruht may consider the Budapest
            [c]riteria as a gold standard for RSD/CRPS cases, it is
            erroneous for [] WCJ [Steiner] to arbitrarily
            determine that Dr. Ruht’s opinion amounts to a legal
            standard for RSD/CRPS diagnoses and determinations
            of full recovery.          Thus, [] WCJ [Steiner]’s
            determination that Dr. Goitz was not credible that
            Claimant fully recovered from RSD/CRPS based on
            Dr. Goitz’s failure to reference the Budapest [c]riteria
            was arbitrary and capricious.
R.R. at 296a-297a (emphasis added).
                                        6
               A review of the transcript, most significantly, Dr. Goitz’s deposition,
reveals that notwithstanding WCJ Steiner’s misstatement concerning the Budapest
criteria, it is clear that the WCJ’s credibility determination was not arbitrary and
capricious.     Specifically, Dr. Goitz based his conclusion that Claimant fully
recovered from RSD/CRPS on the fact that Claimant did not have “typical findings”
which include “loss of motion, atrophy from nonuse, skin changes, hair changes[,
and] temperature changes[, which appear] in the early phases of RSD.” R.R. at
150a (emphasis added). He also based his conclusion on a surveillance video, which
in his opinion showed: “[Claimant] walked with a normal gait, moving her right
hand while she talks [sic] in a normal pattern, holding a cell phone with a right hand
and carrying a tray, all indicating normal use of her hands.” R.R. at 160a. When
asked, “after reviewing the medical records and the surveillance reports that you had
at the time . . . , as well as taking her history, [and] performing the physical
examination,” did you reach an opinion regarding Claimant’s work injury status?
Dr. Goitz replied: “overall it appeared . . . at the time of my exam, she had no
evidence of ongoing RSD or CRPS.” R.R. at 160a.
               When asked if he reviewed all the records, surveillance, and Claimant’s
testimony that were provided between his independent medical exam and his
deposition, and if they supported his opinions, Dr. Goitz replied: “Yes, especially
the further video surveillance.” R.R. at 164a (emphasis added). The reason for
which, he explained: “Just that it continued to show on multiple occasions a normal
use of the right hand with no evidence of modifications of her activities, and using
her hand in very normal patterns, using it to use and move multiple objects.” R.R.
at 164a.      However, WCJ Steiner found, which was his prerogative, that “the
investigative reports and [digital video disc (]DVD[)] surveillance video of Claimant
on January 24, 2020[,] July 2, 2020[,] July 29, 2020[,] and August 4, 2020[,] were
not persuasive in that they only established minimal [] use of her right hand with
                                           7
lifting less than [one] pound, and for which Dr. Goitz relied on heavily to support
his physical examination and opinions, which I hereby reject.” R.R. at 281a.
              Further, Claimant presented Anuradha Anand, M.D.’s (Dr. Anand)
Progress Notes dated July 1, 2020, and July 29, 2020,7 which provided the results of
Dr. Anand’s examinations of Claimant, including: “tender along R[ight] wrist,
swelling and limited [range of motion],” R.R. at 111a, 114a, for which Dr. Anand
assessed Claimant with “CRPS,” id., and prescribed pain medication. See id. WCJ
Steiner “accept[ed] [Dr. Anand’s records] as credible, convincing and persuasive,”
which was within his province. R.R. at 281a. Given WCJ Steiner’s extensive
knowledge of the case, rejection of the investigative reports and DVD surveillance
video, and the acceptance of Dr. Anand’s records, WCJ Steiner’s rejection of Dr.
Goitz’s testimony regarding Claimant’s full recovery of RSD/CRPS was not
arbitrary and capricious.
              The Casne Court explicated:

              [T]he arbitrary and capricious standard cited in PEC
              Contracting Engineers is not only the traditional standard
              applied to credibility determinations, but is strikingly
              similar in substance to the prohibition in Section 422(a)
              [of the WC Act] of rejecting evidence for reasons that are
              irrational.   These concepts provide an appropriate
              paradigm for our analysis. Credibility determinations
              are more than a series of individual findings. Rather,
              they represent the evaluation of a total package of
              testimony in the context of the record as a whole, and
              reflect subtle nuances of reasoning that may not be
              fully articulated, nor even fully appreciated, by the
              fact-finder. Accordingly, we believe that, even where a
              WCJ has based a credibility determination on a cold
              record, substantial deference is due. We must view the
              reasoning as a whole and overturn the credibility

       7
         WCJ Steiner accepted and admitted Dr. Anand’s July 1 and July 29, 2020 Progress Notes
and curriculum vitae into evidence without objection from Employer. See R.R. at 31a-32a.

                                              8
             determination only if it is arbitrary and capricious or
             so fundamentally dependent on a misapprehension of
             material facts, or so otherwise flawed, as to render it
             irrational.

Casne, 962 A.2d at 19 (emphasis added; footnote omitted).
             Here, WCJ Steiner was familiar with the case, as well as Claimant, as
this case was before him numerous times, two of which were specifically to decide
Employer’s Termination Petitions during which Claimant appeared in person, as she
did in the instant Termination Petition. This Court acknowledges that WCJ Steiner
stated in finding of fact (FOF) 24:

             I specifically reject any testimony of Dr. Goitz that
             Claimant has fully recovered and does not require any
             additional medical treatment for Claimant’s work-related
             injury of CRPS/RSD. I additionally note for the
             persuasive value only that in the unreported
             Commonwealth Court [d]ecision of January 22, 2021[,] in
             [Kesselring,] the gold standard for diagnosing RSD or
             CRPS is based on the Budapest [c]riteria, which Dr. Goitz
             did not specifically address other than some of his personal
             observations and his viewing of the DVD surveillance
             videos without any evidence of any recent objective
             diagnostic tests to determine whether or not Claimant has
             continuing CRPS/RSD. Therefore, for all of these
             reasons, [Employer’s] Termination Petition is denied and
             dismissed.

R.R. at 281a; WCJ Steiner Dec. at 12 (FOF 24) (emphasis added). However, that is
just a portion of FOF 24. Before the above-stated quote, WCJ Steiner explained,
relative to the law:

             [The employer] has the burden of proof in a Termination
             Petition to demonstrate by substantial medical evidence
             that all disability has ceased and terminated. [See] Battiste
             v. [Workmen’s Comp. Appeal Bd.] (Fox Chase Cancer
             [Ctr.]), 660 A.2d 253 (Pa. Cmwlth. 1995). This burden is
             considerable because disability is presumed to continue
             until demonstrated otherwise. [See] Giant Eagle[, Inc.] v.
             [Workmen’s Comp. Appeal Bd.] (Chambers), 635 A.2d

                                          9
            1123 (Pa. Cmwlth. 1993). [An e]mployer seeking to
            terminate [WC] benefits must disprove [the c]laimant’s
            existing, continuing right to benefits for injury already
            established to be work related, while [the c]laimant has no
            burden to prove anything at all. [See] Campbell v.
            [Workers’ Comp. Appeal Bd.] (Antietam Valley Animal
            Hosp[.]), 705 A.2d 503 (Pa. Cmwlth. 1998). A WCJ can
            give more credence to a [c]laimant’s testimony regarding
            incapacitating pain than to a doctor’s testimony. [See]
            Victor’s Jewelers v. [Workmen’s Comp. Appeal Bd.]
            (Bergelson), 604 A.2d 1127 (Pa. Cmwlth. 1992). Also, a
            [c]laimant’s complaints of pain, even without evidence of
            an anatomical cause, are sufficient to support a finding of
            continuing disability. [See] JAB Enter[s.], Inc. v.
            [Workmen’s Comp. Appeal Bd.] (Haehn), 470 A.2d 210
            (Pa. Cmwlth. 1984). Where a Termination Petition has
            been denied and the employer again seeks a termination as
            of a later date, the [employer] must show that a change in
            physical condition has occurred since the preceding
            disability determination as held in the case of Lewis . . . .
R.R. at 280a; WCJ Steiner Dec. at 11 (FOF 24).

            WCJ Steiner continued to discuss, in FOF 24, the facts of the instant
Termination Petition:

            I would note that this is [Employer’s] fourth (4)
            Termination Petition as referenced in [FOF] 6. Also, I
            would note that in my decision of February 13, 2019,
            entered into evidence as Judge’s Exhibit 1 in the instant
            proceedings, in which I denied [Employer’s] Termination
            Petition, I had specifically accepted as credible,
            convincing[,] and persuasive the medical evidence of Dr.
            Provenzano and Dr. Razzak that Claimant continued to
            have physical signs and symptoms of RSD/[CRPS] and
            specifically accepted Dr. Provenzano’s assessment that
            Claimant has [CRPS] I of the right upper limb with pain
            in the right hand and that she met the Budapest [] [c]riteria
            as a result of his office examination of March 23, 2018[,]
            as well as Dr. Razzak’s March 14, 2018 physical
            examination and findings. Additionally in that decision, I
            had found Claimant did have signs of some symptom
            magnification, which I continue to find in the instant
            litigation, but note that the investigative reports and

                                         10
            DVD surveillance video of Claimant on January 24,
            2020[,] July 2, 2020[,] July 29, 2020[,] and August 4,
            2020[,] were not persuasive in that they only
            established minimal [] use of her right hand with lifting
            less than [one] pound, and for which Dr. Goitz relied
            on heavily to support his physical examination and
            opinions, which I hereby reject. I accept as credible the
            explanations given by Claimant regarding a DVD
            surveillance video such as her using a cell phone with the
            right hand and emptying a small plastic tray with only
            papers on it at a fast[-]food restaurant and that she has
            good and bad days as far as the use of her right hand.
            Additionally, although much of Claimant’s medical
            evidence was out of date and irrelevant to Claimant’s
            medical condition as of June 17, 2020, it was sufficient to
            establish continued complaints of pain of the right
            hand and diagnosis of CRPS/RSD. I specifically accept
            as credible, convincing[,] and persuasive the medical
            records of Dr. Anand. However, [Employer] is granted
            a termination of Claimant’s work injuries of right thumb
            strain/sprain and right ulnar collateral ligament tear, from
            which Claimant has fully recovered as not having any
            additional medical treatment or care for those conditions
            and for which I accept in part, the testimony of Dr.
            Goitz that Claimant has recovered from those
            conditions and does not require any additional medical
            treatment.

R.R. at 280a-281a; WCJ Steiner Dec. at 11-12 (FOF 24) (emphasis added).
            Clearly, WCJ Steiner’s partial credibility determination of Dr. Goitz
was not based on Dr. Ruht’s medical opinion as the Board declares. Rather, it was
based on, inter alia, his extensive knowledge of the case from presiding over
previous Termination Petitions, Dr. Goitz’s heavy reliance on surveillance videos
which he used to support his physical examination and opinions, Dr. Anand’s
credible, convincing, and persuasive medical records, and Claimant’s medical
evidence.   Although WCJ Steiner may have misstated the Kesselring Court’s
footnote regarding the Budapest criteria, viewing WCJ Steiner’s reasoning as a
whole, this Court cannot hold that the credibility determination of Dr. Goitz is

                                        11
arbitrary and capricious or so fundamentally dependent on a misapprehension of
material facts, or so otherwise flawed, as to render it irrational. Accordingly, the
Board erred by reversing WCJ Steiner’s decision.
            For all of the above reasons, the Board’s order is reversed.

                                      _________________________________
                                      ANNE E. COVEY, Judge

                                        12
         IN THE COMMONWEALTH COURT OF PENNSYLVANIA

Kathryn A. Lawry,                      :
                    Petitioner         :
                                       :
            v.                         :
                                       :
County of Butler (Workers’             :
Compensation Appeal Board),            :   No. 593 C.D. 2022
                  Respondent           :

                                  ORDER

            AND NOW, this 6th day of March, 2024, the Workers’ Compensation
Appeal Board’s May 17, 2022 order is reversed.

                                    _________________________________
                                    ANNE E. COVEY, Judge