Orthopedic Surgeon is Deemed Qualified to Opine as Diabetes Expert in Workers’ Compensation Dispute

Court: Commonwealth Court of PennsylvaniaJurisdiction: FederalCase Name: Steiner v. Workers’ Comp. Appeal Bd. (Automatic Brewers & Coffee)Citation: 2019 Pa. Commw. Unpub. LEXIS 441

Facts

The claimant, an assembly line employee working on cups and pods for espresso machines, filed a claim alleging that, due to the repetitive nature of his work, he developed bilateral carpal tunnel syndrome. His complaint charged that his employer had violated Section 406.1 of the Workers’ Compensation Act by failing to file the documents recognizing his injury on time. His employer denied the allegations, and the matter was referred to a workers’ compensation court. The claimant claimed that he worked exclusively with a machine that required the twisting and repetitive movements of both hands and he started to feel tingling, discomfort, and swelling of his palms. He claims that he told his superiors, but they did not change his tasks.

Despite the discomfort, the claimant did not seek medical treatment because he did not know what was going on. Eventually, he went to a doctor who wrote him a prescription and gave him a note to avoid repetitive gripping, twisting, or lifting his hands. The claimant gave this medical documentation to his supervisor and the company’s owner, but his employer did not accommodate his limitations. He testified that he sought physical therapy twice a week, had to wear a brace, and that the sensations of his hands affected his day-to-day operations, such as pulling on a shirt and buttons. The claimant alleged that the employer wanted him to take a medical leave on unemployment and not to apply for workers’ compensation.

The Diabetes Expert Witness

The defendant employer retained an expert to carry out an independent medical examination of the claimant. The expert was a board-certified orthopedic surgeon with an additional qualification in hand surgery. After his examination, the expert reported the claimant shared his work, accident, and medical history. The claimant also assured the expert that he had no previous problems in his arms or hands and that he was going to seek physical therapy and see a chiropractor three days a week. The expert noted, however, that the claimant had a history of diabetes and dizziness. He ultimately testified that the claimant’s MRI imaging had shown insufficient evidence of work-related trauma.

The expert explained that the claimant had left work due to dizziness, vertigo, and passing out. He also noted that the claimant’s blood glucose level was 313 in the emergency room, and even after six months, the claimant’s blood glucose level was still over 300. The expert testified that his physical examination of the claimant revealed that all the muscles in his wrists, thumbs, forearms, and fingers were working correctly. He stated that only heavy and vibratory repetitive work could be a contributing factor to carpal tunnel syndrome and not simple repetitive work. Based on the claimant’s blood glucose level, the expert determined that the apparent explanation behind the carpal tunnel syndrome was uncontrolled diabetes, which is a well-documented cause of peripheral neuropathy, including carpal tunnel syndrome. Based on this evidence, the workers’ compensation judge denied the claim, which resulted in the present appeal.

Discussion

The claimant alleged that, as the expert opined outside his area of expertise, the workers’ compensation judge’s ruling was not backed by substantial evidence. However, the court noted that “[a]n expert medical witness in a workers’ compensation proceeding is qualified to testify outside of his medical specialty, and any objection to that testimony goes to the weight of the evidence, not its competency,” citing Williams v. Workers’ Compensation Appeal Board (USX Corporation-Fairless Works).

The claimant also argued that the workers’ compensation judge capriciously dismissed the facts, but the appeals court noted that the judge provided thorough summaries of each witness’s evidence. This indicated that the judge did not ignore this evidence, but instead found and dismissed it as inaccurate. Finally, the claimant argued that the judge’s decision was not reasoned, as mandated by Section422(a) of the Act since the expert was not an expert in the field of diabetes. The appeals court observed that the judge had cited the expert’s credentials, his clinical assessment, and his review of medical records and tests, and while the testimony was outside of his medical specialty, this only impacts the weight of the testimony. The appeals court also noted the judge credited the employer’s witnesses and discredited the claimant’s testimony regarding his supposed work injury, thus giving a reasoned judgment.

Held

The claimant’s appeal was denied.