holding that where the causal connection between an injury and the alleged cause is not obvious, the medical witness’ testimony that the injury “might have come” or “possibly came” from the assigned cause is insufficient to sustain the claimant’s burden of proof
How later courts described this case
- holding that where the causal connection between an injury and the alleged cause is not obvious, the medical witness’ testimony that the injury “might have come” or “possibly came” from the assigned cause is insufficient to sustain the claimant’s burden of proof
- cautioning that a tribunal must review the testimony as a whole and not isolate two words from their context
- “Where medical testimony is necessary to establish a causal connection, the medical witness must testify, not that the injury or condition might have or possibly came from the assigned cause, but that in his professional opinion the result in question did come from the assigned cause.”
- testimony of a medical witness must be reviewed and taken as a whole
Written by the judges who cited it.
The opinion
LARSEN, Justice,
dissenting.
The majority prefaces its discussion of the sufficiency of the evidence with the following statements of law:
In workmen’s compensation cases, the claimant has the burden of proving a causal relationship between a work-related incident and his alleged disability. ... Where there is no obvious causal connection between an injury and the alleged cause, that connection must be established by unequivocal medical testimony. ... Where *369 medical testimony is necessary to establish a causal connection, the medical witness must testify, not that the injury or condition might have or possibly came from the assigned cause, but that in his professional opinion, the result in qustion did come from the assigned cause. ... Medical evidence which is less than positive or which is based upon possibilities may not constitute legally competent evidence for the purpose of establishing the causal relationship. ... Majority op. at — (citations omitted; emphasis added).
The underscored portion of this quotation contains a false assumption which, in my opinion, skews the majority’s review of the record for sufficiency of the evidence. That assumption, which leads the majority to search for sufficiency exclusively in the medical testimony, is that there is no obvious causal connection between appellant’s injury and the alleged cause of the injury, namely the work-related incident wherein appellant experienced a sudden, sharp pain in the back of his neck while moving gym equipment weighing several hundred pounds on August 30, 1979. That pain was severe enough that appellant went to see his family physician that evening. On September 4, 1979, five days after the incident at work, appellant was hospitalized for his neck injury. On September 12, 1979, Dr. Nayak operated on appellant to correct this condition. From these facts, as well as the medical evidence, the referee concluded that appellant “has met his burden of proof to show that he suffered an injury 1 in the course of his employment which was related thereto.” I believe this conclusion was proper in light of all the evidence.
In Morgan v. Giant Markets, Inc., 483 Pa. 421 , 397 A.2d 415 (1979), this Court reversed the Commonwealth Court in a similar case, wherein we stated:
The Commonwealth Court held, as a matter of law, that the above facts do not establish the causation because no *370 medical testimony linking the work incident and the injury had been produced. The court relied on Montgomery Mills Co. v. Workmen’s Compensation Board of Appeals, 26 Pa.Cmwlth. 471 , 364 A.2d 508 (1976) which held:
“The long-established rule is that unequivocal medical testimony is required to establish a causal connection between an accident and a disability only where the connection is not obvious”, (citation omitted).
In interpreting Montgomery Mills, supra, the court held that in the instant case the causal connection between the work incident and the injury was not obvious, and, therefore, medical testimony was needed.
We are reversing the Commonwealth Court in the instant case. Where one is doing an act that requires force or strain and pain is experienced at the point of force or strain, the injury may be found to have been established. Pain is an excellent symptom of an injury. Of course, the trier of fact will determine the credibility of the witness’s testimony as to the total situation. We, therefore, find substantial competent evidence in the record to support the conclusion of the Workmen’s Compensation Board of Appeals, that the above facts establish a causal connection between the work incident and appellant’s injury. Pages Department Store v. Velardi, 464 Pa. 276 , 346 A.2d 556 (1975).
483 Pa. at 423-24 , 397 A.2d 415
So too in the instant case, appellant’s own testimony regarding the incident at work on August 30, 1979 and his immediately subsequent medical history is substantial competent evidence which supports the referee’s conclusion that he had suffered a work-related injury even in the absence of medical testimony.
Moreover, contrary to the majority I believe the deposition offered on behalf of appellant also supports the referee’s conclusion. In this regard, I find Judge Barbieri’s dissenting opinion in this case persuasive. That opinion states:
*371 I must dissent because it is clear to me that the testimony of the only medical witness in the case, read as a whole, contains opinion statements that are sufficiently positive to support the referee’s finding that a medical or causal relationship exists between the aggravating injury and the disc conditions, and that, therefore, the Workmen’s Compensation Appeal Board erred in reversing the referee’s award. Accordingly, I would reverse and reinstate the referee’s decision.
While it is true that some statements in the testimony of Dr. Narayan T. Nayak, standing alone, may be insufficient to support a finding of causal relationship, I believe that the following testimony contains opinion assertions that are sufficiently positive to support such a finding:
[testimony omitted].
As I read the above, giving to the words the interpretation that will best support the referee’s findings, as I must, it amounts to this: that the claimant’s injury was “due to an acute trauma,” significant if not itself sufficient, Morgan v. Giant Markets, Inc., 483 Pa. 421 , 397 A.2d 415 (1979); that the relationship is so compellingly obvious that “I have to believe ...,” if the claimant’s testimony is accepted, which it was, “that his condition was severely aggravated” following the injury at work; that the doctor is “without doubt” that the herniated disc came “from that particular incident,” although prefaced by the word “assume;” that “this is, again, an aggravation at the time of the injury;” and “that the episode of August 30 was an aggravation of a preexisting condition,” which, although in the context of a leading but unobjected to question, was answered in a clear affirmative, establishing that the episode on August 30, 1979 “was responsible for this herniation of the disc.”
My research indicates that this Court, the Superior Court and the Supreme Court have never required more, *372 but have often approved less, (numerous citations omitted).
472 A.2d 1178 -79.
Based upon the foregoing, I would reverse the order of the Commonwealth Court and reinstate the referee’s award of benefits.
. As defined by the Workmen’s Compensation Act, 77 P.S. § 411(1), "injury” means “an injury to an employe, regardless of his previous physical condition, arising in the course of his employment and related thereto ....’’