Metropolitan Ambulance, Inc. v. Workers' Compensation Appeal Board

702 A.2d 881, 1997 Pa. Commw. LEXIS 859, 1997 WL 716593
CourtCommonwealth Court of Pennsylvania
DecidedNovember 19, 1997
DocketNo. 1738 C.D. 1997
StatusPublished
Cited by4 cases

This text of 702 A.2d 881 (Metropolitan Ambulance, Inc. v. Workers' Compensation Appeal Board) is published on Counsel Stack Legal Research, covering Commonwealth Court of Pennsylvania primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Metropolitan Ambulance, Inc. v. Workers' Compensation Appeal Board, 702 A.2d 881, 1997 Pa. Commw. LEXIS 859, 1997 WL 716593 (Pa. Ct. App. 1997).

Opinion

NARICK, Senior Judge.

The issue in this appeal is whether there is substantial evidence to support the termination of a claimant’s benefits under the Workers’ Compensation Act (Act),1 where the employer’s medical witness testified that the claimant is physically recovered from his work-related disability but that he may be suffering from a “functional overlay,” and where neither the Workers’ Compensation Judge (WCJ) nor the Workers’ Compensation Appeal Board (Board) specifically addressed the issue of a possible “functional overlay.”2

Metropolitan Ambulance, Inc. (Employer) appeals the order of the Board, which held that the WCJ erred in terminating the benefits of Allan Walker (Claimant) because “there is no substantial evidence that supports the WCJ’s decision.” Because this case appears to turn on the issue of whether Claimant suffers from a work-related, disabling “functional overlay,” and because neither [883]*883the Board nor the WCJ addressed this issue, we vacate the decision of the Board and remand in accordance with this opinion.

Claimant was injured during the course of his employment on April 30, 1987, and total disability benefits were subsequently paid by Employer. On July 5, 1988, Employer filed a termination petition with the Bureau of Workers’ Compensation, requesting that Claimant’s benefits be terminated on the grounds that he was fully recovered from his work-related injury as of April 12,1988.

At the hearing before the WCJ, Employer offered the deposition testimony of Leonard Klinghoffer, M.D., who was found by the WCJ to be credible and who testified as follows:

Q. Doctor, based on the history that you obtained in the examination, the test you reviewed, do you have within a reasonable degree of medical certainty an opinion regarding Mr. Allan Walker?
A. Yes- My examination does not reveal any physical abnormality aside from a curvature of the spine. That condition, the curvature, could very well have made his symptoms after the accident last longer than they would have lasted in someone with[out] a curvature. And on the basis of that curvature I offer the opinion that he might still have some intermittent low back symptoms but I could not explain significant pain or I could not explain symptoms ‘almost all the time’ and I therefore suspect that there was some degree of superimposed functional overlay that was magnifying his complaints. (Emphasis added.)
‡ ‡ ‡ ‡
Q. Doctor, you are stating that any abnormal findings that you might have listed in your report are totally unrelated to this work related injury.
A. I think that the physical findings are all those of the scoliosis [i.e., a genetic curvature of the spine]. There are no physical findings now that I can relate to the accident two years before I saw him. (Emphasis added.)

In granting Employer’s termination petition, the WCJ made the following relevant finding of fact:

25. Based on the evidence, particularly Dr. Klinghoffer’s testimony, the judge finds that the claimant [has] no physical findings related to the claimant’s work injury....

For the purposes of this appeal, it is crucial that, while both Dr. Klinghoffer and the WCJ stated that there was no physical evidence that Claimant remained disabled, the WCJ did not address Dr. Klinghoffer’s opinion that Claimant’s reports of “significant pain” or pain “almost all the time” could be the result of a “functional overlay,” which is defined below.

Claimant subsequently appealed the WCJ’s decision to the Board, which on May 29, 1997 reversed the WCJ and reinstated Claimant’s benefits on the generalized grounds “that there is no substantial evidence that supports the WCJ’s decision.” Also critical to this appeal, the Board did not directly address Dr. Klinghoffer’s opinion that Claimant may be suffering from a “functional overlay,” and in fact never even mentioned this term, although that could have been sufficient reason to reverse the WCJ and could have been the Board’s reason for finding a lack of substantial evidence, but it is not clear from the Board’s opinion.

On appeal to this Court, both Claimant and Employer devote significant attention to the question of what Dr. Klinghoffer meant by the term “functional overlay,” even though the question was not addressed by the WCJ nor was the term mentioned in the opinion of the Board, although, as noted above, Dr. Klinghoffer’s comment that Claimant may have a “functional overlay” could have been the reason that the Board found no substantial evidence to support the WCJ’s decision.

Before addressing the parties’ positions on the “functional overlay” issue, it is important to define this term:

The term ‘functional overlay’ has been defined as an impairment, apparently physical, affecting the use or operation of some bodily part, but without measurable structural or organic change, usually produced [884]*884by an emotional or mental abnormality or conflict. It may overlay, compound or even obscure symptoms of a co-existing true organic disease. A disability resulting from a work-related physical injury later supplemented by a psychogenic component is referred to as a ‘functional overlay’ and, because it is the result of the work-related, injury, is fully compensable.

County of Dauphin v. Workmen’s Compensation Appeal Board (Davis), 136 Pa. Cmwlth. 140, 582 A.2d 434 (1990), appeal denied, 528 Pa. 614, 596 A.2d 160 (1991) (citations omitted) (emphasis added).

Employer argues that, when Dr. Klinghoffer used the term “functional overlay,” he was attributing it to Claimant’s genetic scoliosis, not Claimant’s 1987 work-related injury. Claimant, by contrast, argues that an employer fails to meet its burden of proving that a claimant’s work-related disability has ceased where the claimant’s condition can be attributed to a “functional overlay.”

An employer seeking termination of a claimant’s workers’ compensation benefits has the burden of proving by substantial evidence that all of the claimant’s work-related disability has ceased. Battiste v. Workmen’s Compensation Appeal Board (Fox Chase Cancer Center), 660 A.2d 253 (Pa.Cmwlth.1995). Where a current disability exists and the employer seeks to terminate benefits, the employer has the burden of proving an independent cause for the disability or a lack of a causal connection between the continuing disability and the work-related injury. Id. This burden is considerable because disability is presumed to continue until demonstrated otherwise, and the burden never shifts to the claimant in a termination proceeding to prove the existence of a causal connection between the disability and the injury. Id.

In Davis, the employer’s medical witness at a termination petition hearing opined that the claimant was no longer disabled from her work-related injury because her pain resulted from a “functional overlay” rather than a physical cause.

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Bluebook (online)
702 A.2d 881, 1997 Pa. Commw. LEXIS 859, 1997 WL 716593, Counsel Stack Legal Research, https://law.counselstack.com/opinion/metropolitan-ambulance-inc-v-workers-compensation-appeal-board-pacommwct-1997.