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McGuin v. State Compensation Insurance Fund12/16/1999
as more likely than not that the river float caused the fistula, he replied:
A. Since I can't think of any other event that would be more suspect than that, I think that's probably the best answer to when it occurred. There's no other history that I can flush out in taking a history from him that would try and place this at another time. (Id. at 46.)
When asked what would have caused the fistula during the river float, he explained:
A. The pressure difference from the dive, the possibility of doing Valsalva maneuver vigorously trying to get his ears to clear would be another time that it actually tore. Those would be the main things I would think of. (Id.)
Following his first, failed surgery, claimant was treated by Dr. Von Doersten, who practices in Missoula. Dr. Von Doersten is an otolaryngologist with specialized training in skull base surgery and neurotology. (Von Doersten Dep. at 6-7.) He specializes in ear and skull base surgery (id.), and performed the second and third surgeries on claimant's ear. (Ex. 2 at 92-107.)
Dr. Von Doersten confirmed the existence of a perilymph fistula. (Id.) With regard to the cause and onset of the fistula, he put claimant's activities in the 1986 Dive Rescue II at the "top" of his list of possible causes. (See Von Doersten Dep. at 40.) He testified that " t seemed likely that [the 1986 school] was an activity which could lead to a purulent fistula" (id. at 24) and that it was logical to view the 1988 and 1991 dives as aggravating the condition (id. at 34). Ultimately, he opined that it was "most likely that things began in '86." (Id. at 44.)
Dr. Youngblood testified in two depositions, the first taken by claimant's counsel on May 20, 1999 (Youngblood Dep. I), and the second taken by the State Fund's counsel on June 14, 1999 (Younblood Dep. II). Dr. Youngblood specializes in dive and hyperbaric medicine. (Youngblood Dep. I at 7-8.) He is board certified in both occupational medicine and hyperbaric medicine. (Id. I at 12.) He has extensive experience in diving accidents, 50 percent of which are related to ear and inner ear injuries or difficulties. (Youngblood Dep. II at 25.) He has diagnosed perilymph fistulas in diving accidents but does not treat them. (Id. II at 53-54.) He has never performed surgery on a fistula. (Id. II at 54.)
Dr. Youngblood testified that it is most likely that claimant's fistula was caused by his 1991 swimming pool dive. (Id. II at 52.) Alternatively, he said that the fistula might have initially occurred in the 1988 Lake Koocanusa dive, but if so it had healed and was reopened in the 1991 pool dive. (Id.) At minimum, he felt that the 1991 incident represented a significant aggravation of a pre-existing condition. (Id.)
Dr. Youngblood conceded it was possible that the fistula first occurred during the 1986 dive school. (Id. II at 39, 50.)
Having carefully considered the deposition testimony of the three physicians, I am persuaded that the evidence preponderates in favor of a finding that the 1986 river float caused claimant's perilymph fistula. Both treating physicians support that finding, testifying that the 1986 river float more likely than not caused it. I found their testimony more persuasive because they diagnose and treat perilymph fistulas as a part of their regular medical practices, and do so without regard to whether they arose in diving accidents. In contrast, Dr. Youngblood's familiarity with perilymph fistulas is limited to diving accidents and he does not treat them. The treating physicians had broader expertise regarding causation and had more specialized knowledge of the conditions based on their regular treat
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