On appeal from the Department of Labor, Division of Workers' Compensation.
NOT FOR PUBLICATION WITHOUT THE APPROVAL OF THE APPELLATE DIVISION
Before Judges Lintner, Parrillo and Graves.
Respondent, Associated Podiatric (Associated), appeals from a Division of Workers' Compensation order awarding temporary medical benefits to petitioner, Maria Coleman. Specifically, the Workers' Compensation judge found that Coleman's bilateral carpal tunnel syndrome was causally related to her repetitive job duties performed while in Associated's employment. Associated contends that the judge's conclusions were: (1) not supported by the evidence; (2) based upon an inadmissible net opinion given by Coleman's expert; and (3) predicated on an preliminary EMG report rather than the raw data. We reject Associated's contentions and affirm.
Coleman was hired by Associated in April 2005, as a podiatric medical assistant. Prior to that time, Coleman was employed at H&R Block, where she performed data entry and customer service support 35-40 hours per week. Coleman's duties at Associated included rubbing lotion on and massaging the feet of patients, assisting patients in taking off and putting on their shoes, scrubbing out whirlpool baths after patients had finished using them, sweeping the examination rooms, taking out the trash, developing x-rays, and filing charts and other paperwork.
In August 2005, Coleman began to experience problems with her hands. She consulted her family physician, Dr. Clinton Ogolo,*fn1 who gave her medication and referred her for an electromyography (EMG) and nerve conduction velocity (NCV) study. An EMG/NCV was performed at Capital Health System on September 16, 2005. Ogolo referred Coleman to Dr. Thomas Bills, an orthopedic surgeon, who examined her on January 18, 2006. Bills reviewed the EMG/NCV study. He reported that it confirmed bilateral carpal tunnel syndrome, mild on the left hand and moderate on the right hand. Bills noted that Coleman reported "that she [had] started a new job in April" and that it involved "a lot of repetitive motion." On the basis of the history provided by Coleman, Bills advised her "that there was a possible cause and [effect] relationship between her carpal tunnel syndrome and her work-related activities." Shortly after her visit with Bills, Coleman reported her condition to Associated. Associated's owner called Bills, who advised that Coleman had permission to return to work despite her condition. Associated altered Coleman's hours, giving her less work time.
Coleman filed her claim petition on February 8, 2006, and continued to work for Associated until June 2006, when she was fired for failing to return to work as scheduled following a vacation. On February 27, 2006, Coleman was examined by Elliot L. Ames, D.O., at Associated's request. On March 1, 2006, Dr. Ames issued a report diagnosing Coleman with "[b]ilateral carpal tunnel syndrome, the right greater than the left." "In terms of causal relationship," he wrote:
I would find causal relationship [of the carpal tunnel syndrome to employment with Associated] only if there is no history of thyroid disease. The patient reported a questionable history of elevation of her thyroid function studies. If this proves to be the case, upon review of records from her family physician, then causal relationship would not be established with any degree of medical certainty. There are no other risk factors other than the possibility of thyroid disease. If her thyroid studies were negative, then I would find causal relationship. (Emphasis added.)
Ames did not perform any subsequent examinations of Coleman, however, he wrote two additional reports. The first was dated May 1, 2006. He wrote that "the thyroid profile performed on November 9, 2005 was normal. Therefore it [did] not appear that thyroid disease [was] a factor." He requested a copy of the EMG performed in September 2005. However, in the second report, dated August 28, 2006, Ames reported that a December 8, 1999, laboratory study found "a low free T3-4 index" with respect to Coleman's thyroid function. Ames concluded that "[t]he laboratory studies did show evidence of low thyroid function which is a risk factor." He noted, "[a]dditionally there is obesity . . . another risk factor for Carpal Tunnel Syndrome." He concluded that he was "unable to establish causal relationship with any degree of medical certainty."
In September 2006, Coleman began working for Delaware Valley Pediatrics as a receptionist 27 hours per week, checking patients in and out and verifying the information patients filled out on various medical forms, as well as doing some light filing. She used a computer to perform many of her daily work functions.
Coleman filed her application for medical and temporary benefits on September 7, 2006. In support of her claim, she was evaluated by David Weiss, D.O. In a report dated November 14, 2006, Weiss set forth Coleman's medical history, reviewed her complaints, her prior medical reports, and the EMG/NCV report. Weiss found that Coleman presented "with a classic case of a cumulative and repetitive trauma disorder manifesting itself as a bilateral carpal tunnel syndrome," and because "she has failed conservative care . . . [she] should be scheduled for an open bilateral carpal tunnel release" to be performed by her treating orthopedic surgeon.
Testimony was taken over the course of four hearings. Coleman described her job duties with Associated, which included sweeping out examination rooms twice per day, helping elderly patients take off and put on their shoes and socks, rubbing lotion onto and massaging patients' feet, assisting patients into the whirlpool bath, and scrubbing the tub after they had finished. She also helped develop x-rays taken at the practice and was often required to carry several heavy metal trays, used to develop x-rays, up and down the stairs.
Coleman described her symptoms, as well as the limitations on her daily activities. She confirmed on cross-examination that she had worked for H&R Block full-time, where she used a mouse with both hands, prior to her employment with ...