No. 593 C.D. No. 593 C.D. 2022
OPINION BY: Judge Covey / FILED: March 6, 2024
In a Nutshell: An Examination Protocol Referred To By A Physician Testifying In A Workers‘ Compensation Matter As The Gold Standard In Diagnosing And Determining Recovery From RSD/CRPS Is Not Binding On The WCJ In A Different Case Involving The Same Conditions.
In adjudicating the Termination Petition filed by Employer, Workers’ Compensation Judge (WCJ) Steiner determined that the burden of proof assumed upon filing the petition to show full recovery from Claimant’s (reflex sympathetic dystrophy (RSD) and complex regional pain syndrome CRPS) had not been met. In doing so, the WCJ referenced the case of Kesselring v. Workers’ Compensation Appeal Board (Pocono Medical Center and Qual-Lynx), (Pa. Cmwlth. No. 1786 C.D. 2019, filed Jan. 22, 2021). A different physician testifying in that case stated that the gold standard for diagnosing these medical conditions is the “Budapest criteria” and that testifying on behalf of Employer in the instant case Dr. Robert Goitz had given his opinion of recovery without specifically addressing the Budapest criteria. Additionally, the WCJ found there was the absence of any evidence of recent objective diagnostic tests to determine whether the Claimant had continuing RSD/CRPS.
The Workers Compensation Appeal Board (WCAB) reversed the WCJ‘s decision denying the termination petition based on Dr. Goitz’s failure to adhere to the “Budapest criteria”. The WCAB considered the WCJ’s ruling in this regard as arbitrary and capricious.
The Court pointed out that Dr. Goitz had based his opinion of full recovery on his examination of Claimant and review of surveillance films showing Claimant on multiple occasions making normal use of his right hand with no evidence of modification of her activities.
The Court noted, however, that the WCJ found the surveillance films not to be persuasive in that they only established minimal use of her right hand with lifting less than 1 pound. Further, the WCJ stated that Dr. Goitz had relied heavily on these surveillance films to support his physical examination and opinions which the WCJ rejected.
The WCJ also relied on the progress notes of a treating physician, noting the presence of the finding upon examination of “tender[ness] along right wrist, swelling, and limited range of motion.” The WCJ accepted these medical records as credible, convincing, and persuasive.
The Court also noted that the “Budapest criteria” was simply mentioned in a footnote in Kesselring, supra and it is unclear what level of standardization the “Budapest criteria” has reached, if any, among the medical community concerning RSD/CRPS diagnosis and recovery determinations.
Accordingly, the court reversed the order of the WCAB and affirmed the WCJ’s determination that Claimant had not fully recovered from her compensable injuries.
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