Rummage v. BGF Industries ( 2021 )


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  •                     THE STATE OF SOUTH CAROLINA
    In The Court of Appeals
    Vickie Rummage, Employee, Appellant,
    v.
    BGF Industries, Employer, and Great American Alliance
    Insurance Co., Carrier, Respondents.
    Appellate Case No. 2018-000359
    Appeal From The Workers' Compensation Commission
    Opinion No. 5822
    Heard September 23, 2020 – Filed May 19, 2021
    AFFIRMED
    Andrew Nathan Safran, of Andrew N. Safran, LLC, of
    Columbia, for Appellant.
    Michael Allen Farry and Jeremy R. Summerlin, both of
    Horton Law Firm, P.A., of Greenville, for Respondents.
    KONDUROS, J.: Vicki Rummage (Claimant) appeals the order of the Appellate
    Panel of the South Carolina Workers' Compensation Commission (the Appellate
    Panel) denying her claim for aggravation of a preexisting psychological condition.
    We affirm.
    FACTS/PROCEDURAL BACKGROUND
    Claimant worked the third shift as a weaver for BGF Industries. On May 18, 2012,
    at approximately 3 a.m., she fell after stumbling backward into a hand truck that
    had been placed behind her while she was doffing her weaving machine. Claimant
    fell backward and struck her head causing a laceration and scrape marks along her
    neck. She declined going to the hospital at that time, and the wound was closed
    with glue from the company's first aid supplies. She finished her shift but later
    stated she had some blurred vision and a headache after the accident. She drove
    home and returned to work for her next shift two days later. Claimant worked for a
    week, and her supervisor sent her for evaluation at the local hospital where she had
    a CT scan that showed normal results.
    Dr. John McLeod, III, a workers' compensation physician for BGF Industries and
    its insurer Great American Alliance Insurance Co. (collectively, Respondents),
    evaluated Claimant on May 30, 2012, and noted he "suspected some element of
    concussion." It was noted her medications included Xanax, Percocet, Prinivil,
    Lopid, Fiorcet, Ambien, and Lorcet. She complained of headaches and soreness in
    her upper back and neck. A follow-up appointment on June 6, 2012, did not reveal
    any significant new information.
    In September 2012, Claimant was referred to Dr. Jeff Benjamin at Grand Strand
    Specialty Associates. Claimant admitted a history of migraine headaches to Dr.
    Benjamin but indicated the ones she was suffering post-injury were different and
    "quite excruciating." She also complained of fatigue, nausea, blurred vision,
    spasms in her legs, and mood swings. Dr. Benjamin noted Claimant's symptoms
    were consistent for closed-head injury. She subsequently complained of fogginess
    and extreme fatigue. Claimant began physical therapy for her neck and was
    prescribed Trileptal for headaches and cervical strain. Claimant reported being an
    "emotional mess" based on the nausea and headaches she was experiencing. Dr.
    Benjamin gave Claimant trigger point injections,1 and she received an occipital
    nerve block. Eventually, in November, Dr. Benjamin indicated he did not think
    there was much more he could do to assist Claimant except refer her to a pain
    clinic.
    In December of 2012, Claimant began seeing Dr. Daniel Collins, another workers'
    compensation physician, who treated her for the next three years. His initial note
    1
    "A trigger point injection (TPI) is an injection that is given directly into
    the trigger point for pain management. The injection may be an anesthetic such as
    lidocaine (Xylocaine) or bupivacaine (Marcaine), a mixture of anesthetics, or a
    corticosteroid (cortisone medication) alone or mixed with lidocaine." Catherine
    Burt Driver, M.D., Trigger Point Injection, MedicineNet (July 30, 2020),
    https://www.medicinenet.com/trigger_point_injection/article.htm.
    reflects a prior medical history of only sinus troubles. Claimant complained of
    pain in her neck and head, ringing in her ears, and lightheadedness with slight
    memory loss. Dr. Collins prescribed Neurontin, which Claimant indicated she had
    not tried before; physical therapy; and a speech therapy evaluation. In a follow-up
    a month later, Dr. Collins's notes reflect Claimant was attending speech therapy for
    mild cognitive impairments, physical therapy, and she would begin taking Lyrica.
    Claimant was still experiencing significant headaches and neck pain. In the
    following months, Dr. Collins noted worsening depression. He administered
    trigger point injections for neck pain and Botox injections for headaches. He
    prescribed various medications for depression, anxiety, sleep issues, and pain.
    Claimant attended speech therapy with Martha Williams at Sandhills Regional
    Medical Center Rehab Services beginning in January 2013. After testing,
    Williams reported Claimant had mild impairment of attention, memory, executive
    function, and visuospatial skills. Williams indicated Claimant's fatigue or
    preoccupation would increase deficits to a moderate level. Williams worked with
    Claimant to use different strategies to manage and complete daily tasks. On
    Williams's advice, Claimant was using games to aid with focus and cognitive
    abilities. By October, Williams noted improvements in language and task
    management but the therapy had benefitted Claimant as much as possible at the
    time.
    During the course of litigation, it was discovered Dr. Fred McQueen had treated
    Claimant for years prior to her workplace injury for various conditions. His notes
    in the record begin in 2006 and continue to the date of Claimant's injury and a few
    months beyond. In 2006, Dr. McQueen noted Claimant suffered from cervical and
    lumbrosacral disc disease with radiculopathy down her extremities. Over the
    course of the next six years, Dr. McQueen prescribed a variety of medications for
    anxiety, depression, sleep problems, muscle spasms and soreness, headaches, and
    pain. He noted the various stressors in her life including caring for her husband
    and adult son, who both suffered health issues, caring for both parents through the
    end of their lives, and working multiple jobs. He noted twice he was concerned
    with how much longer Claimant would be able to keep working like she was and
    that her body was breaking down. Dr. McQueen's notes characterize her at times
    as having chronic depression and chronic pain, and the notes consistently showed
    she was taking medication for pain and Xanax, while the prescribing of some other
    medications seem to fluctuate slightly in being prescribed or filled.
    Respondents deposed Claimant in December 2013. She testified she had a
    previous workers' compensation claim with a different employer in 2007 that had
    been denied, she had not been represented by an attorney in that case, and that it
    did not progress to a hearing. She also denied being deposed in the prior case.
    With regard to her treatment and condition after her fall, Claimant testified she
    complained of neck, arm, back, and leg pain during her visit with Dr. McLeod but
    was mainly concerned with her head. Claimant testified she then saw Dr.
    Benjamin and complained of neck and head pain. She next saw Dr. Collins and
    provided him with a history of Dr. Benjamin's treatment but according to Claimant,
    Dr. Collins did not ask about any other prior medical history. Claimant
    acknowledged Dr. McQueen had given her pain medications in the past but
    claimed she could not remember if it was for her neck and back; she thought it was
    mainly for her leg. Claimant also acknowledged Dr. McQueen had prescribed
    depression medications for her in the past when she was experiencing difficult
    times. She only recalled taking blood pressure medication at the time of her
    workplace injury. Claimant indicated the problems that began after her fall
    included headaches, dizziness, ringing in the ears, loss of memory, depression, and
    neck pain. She stated her neck pain radiated down her arm and she had not had
    similar neck or arm pain before. Finally, Claimant stated she could no longer
    manage her housework or caregiving duties and she is very easily confused and
    distracted. She indicated she sometimes used Facebook to stay in touch with
    people and played games on the computer for short periods of time as
    recommended by her speech therapist.
    Dr. Collins's deposition was taken March 13, 2014. He stated he was not made
    aware of a lot of Claimant's prior medical history which concerned him. He stated,
    "[I]t's really impossible to tell at this point how much or how little the work injury
    from May 2012 played into symptoms that she had apparently been experiencing
    for a few years, several years." Dr. Collins noted some of Claimant's current
    medications were very similar to prior medications, but some of them were new,
    for example the Botox injections. Dr. Collins stated, "It becomes harder and
    harder to figure out what is related specifically to the work injury from May and
    what is possibly an exacerbation of a preexisting or possibly a completely new
    diagnosis." Dr. Collins noted Claimant's speech issues were new and that he had
    no doubt she wanted to get better. Dr. Collins opined a long-term physician would
    be able to give the best information about the progression of her issues.
    That same day, March 13, 2014, Dr. McQueen, Claimant's long-time physician
    completed a form sent to him by Claimant's attorney in January. It indicated Dr.
    McQueen's opinion, to a reasonable degree of medical certainty, that Claimant's
    current headaches, frequency of cervical symptoms, and depression were made
    worse by her fall and were consistent with post-concussive syndrome. He also
    opined the treatment for these aggravated symptoms was different and more
    focused than prior to the fall and she was previously able to continue to work in
    spite of any preexisting conditions.
    Several specialists evaluated Claimant for this case. Tora Brawley, Ph.D., a
    clinical psychologist and neuropsychologist, evaluated Claimant on May 15, 2014.
    Claimant's neurocognitive test was discontinued due to interference of her
    psychiatric symptoms, and Dr. Brawley indicated Claimant could be reevaluated
    once those were better managed. Dr. Brawley stated "formal assessment of effort
    did not reveal attempts to malinger." Dr. Amanda Salas, a forensic psychiatrist,
    evaluated Claimant in April 2015 and issued a report of her findings in September
    2015. Dr. Salas indicated Claimant presented as honest and determined, not overly
    exaggerated or dramatic. In talking with Claimant, Dr. Salas observed she had
    trouble with landmark dates and some word-finding difficulties. Claimant's
    husband stated Claimant had gotten lost driving in familiar places and had frequent
    crying spells. Dr. Salas diagnosed Claimant with Major Depressive Disorder,
    different than her prior depression. She opined Claimant was not at maximum
    medical improvement as to mood symptoms and memory impairments, and that
    she should be stabilized emotionally and then evaluated for cognitive deficit.
    Finally, Dr. Donna Schwartz Maddox, a psychiatrist with added qualifications in
    forensic psychiatry, interviewed Claimant in June of 2014 and prepared a report
    dated April 2016.2 Dr. Maddox stated Claimant was not malingering and exhibited
    good effort on the cognitive portion of her mental status exam and did not over
    endorse symptoms. She noted Claimant's pseudobulbar affect3 was difficult to
    feign. Dr. Maddox indicated that, in her opinion, Claimant had increased
    depression since the accident and needed therapy along with better
    pharmacological treatment. Claimant's neurocognitive deficits could then be
    evaluated. Dr. Maddox met with Claimant again in October of 2016 and opined
    she remained depressed with a flat and tearful affect.
    All of the aforementioned providers reviewed Claimant's prior medical history, and
    Claimant acknowledged prior depression and osteoarthritic pain to each. Claimant
    2
    No explanation is provided for the delay between the interview and report.
    3
    "Pseudobulbar affect . . . is a condition [that is] characterized by episodes of
    sudden uncontrollable and inappropriate laughing or crying. Pseudobulbar affect
    typically occurs in people with certain neurological conditions or injuries, which
    might affect the way the brain controls emotion." Mayo Clinic,
    https://www.mayoclinic.org/diseases-conditions/pseudobulbar-affect/symptoms-
    causes.
    also complained to each of worsening depression and headache pain in addition to
    the new symptoms previously mentioned including ringing in the ears, memory
    loss, speech impairment, low energy, and a general inability to focus.
    In April 2015, at Employer's request, Claimant was evaluated at NC
    Neuropsychiatry in Charlotte, North Carolina.4 Dr. Thomas Gualtieri administered
    various tests to Claimant, which primarily involved her responding to questions on
    a computer. Dr. Gualtieri stated:
    The patient's evaluation today demonstrates a non-
    credible clinical presentation with dramatic
    inconsistencies. The patient's overt memory performance
    and indeed general appearance, fluency and lucidity is
    quite a variance with her claimed symptomatology.
    There was clear evidence of symptom exaggeration.
    There is no reason to believe that her current problems
    are related to a head injury . . . . [H]er subsequent course
    is not at all typical of recovery from concussion.
    He opined Claimant may suffer from somatization disorder.5
    Drs. Brawley and Salas both questioned Dr. Gualtieri's choice of tests and
    methodology. Additionally, they both felt the results of Dr. Gualtieri's testing were
    invalid because Claimant's significant depressive disorder would interfere with her
    performance, rendering them unreliable.
    Dr. Gualtieri responded to the criticisms of his evaluation. He indicated a main
    factor in evaluating brain injury was the nature of the initial injury itself and
    Claimant's description of the injury and delay in seeking treatment rendered this a
    "non-event." In light of her history, it was not reasonable to assume any current
    issues were attributable to her fall. Dr. Gualtieri also expressed the validity of his
    Neuropsych Questionnaire test and noted it was more reliable than just an
    interview assessment of whether a person was exaggerating or feigning symptoms.
    4
    The report is actually dated 12/11/14, but Employer indicates that was error.
    Claimant suggests the erroneous date indicates this was something of a canned
    report preprepared by Dr. Gualtieri.
    5
    "Somatization occurs when psychological concerns are converted into physical
    symptoms." GoodTherapy, https://www.goodtherapy.org/learn-about-therapy
    /issues somatization (last visited December 11, 2020).
    He cited to numerous journal articles he had authored on the subject. Dr. Gualtieri
    indicated Claimant had presented herself well and recalled her history fluently
    although she was occasionally tearful. He stated she did not appear depressed and
    was not impaired from taking the tests he administered. Additionally, the test
    scores she received were inconsistent with each other and not consistent with a
    profile of someone with a traumatic brain injury.
    After all the evaluations, and after having provided Claimant's prior medical
    history in full, Claimant's attorney solicited final opinions—such as the one issued
    by Dr. McQueen—from Dr. Collins, Dr. Salas, and Dr. Maddox. They all opined
    to a reasonable degree of medical certainty Claimant was not malingering,
    presented clinical evidence of depression and anxiety (probably Major Depressive
    Disorder), had suffered an increase in her psychological issues after her workplace
    injury, had not reached MMI, and required psychiatric treatment including therapy.
    Finally, a hearing on Claimant's case was held in November of 2016. At that time,
    Claimant acknowledged seeing Dr. McQueen and that she had previously struggled
    with depression, including taking medication for it. However, she indicated it was
    nothing she was not able to overcome; she was working, taking care of her
    responsibilities, and never received psychiatric therapy. Claimant testified she had
    headaches before her fall but the ones after the accident were different. The nausea
    accompanying her headaches became worse, and she began experiencing new
    symptoms including ringing in the ears, speech issues, and dizziness. Claimant
    indicated she received Botox injections from Dr. Collins and was prescribed
    medications that helped. However, after Dr. Collins left his practice she "got
    nothing." At the time of the hearing, she was no longer receiving workers'
    compensation benefits and was not receiving Botox injections. She indicated her
    crying and depression were worse, she could not be in a crowd, and did not "have a
    life" anymore. She also testified her memory issues were new. Claimant further
    testified she used Facebook at her speech therapist's suggestion as a means to stay
    in contact with people. Her primary Facebook activity centered on offering
    prayers to others and commenting on pictures of her grandchildren and their
    activities. Claimant indicated she had not tried to hide prior issues from her
    providers.
    On cross-examination, Claimant stated she did not go to the doctor immediately
    after her accident and continued working until August 2012, approximately three
    months after the injury, although she struggled every day. She acknowledged
    taking medication for pain and depression since 2005. She admitted her
    medications had included Xanax, Ambien, and Cymbalta. Claimant acknowledged
    receiving medications for pain and depression in 2007 and 2009, while being
    treated for pain, depression, anxiety, and headaches. Claimant did not recall her
    specific medications, but again, did not dispute anything reflected in the records.
    In December 2009, Dr. McQueen was still treating Claimant for chronic pain,
    migraines, and generalized anxiety disorder (GAD), but according to Claimant
    these issues were not like they became after the accident. Claimant did not recall
    how she responded during her deposition to questions about her prior workers'
    compensation claim except that her husband's insurance had paid for her shoulder
    surgery which was the subject of the claim. Claimant remembered being treated
    for pain prior to the accident but she did not know if it was called chronic pain.
    She admitted Dr. Collins prescribed some of the same medications as Dr.
    McQueen had previously for depression and anxiety.
    The single commissioner denied Claimant's claim, by and large based on her
    assessment of Claimant's credibility. The single commissioner found Claimant to
    be "wily and manipulative" and noted her belief Claimant was "using the
    worker[s'] compensation system for purposes of secondary gain." The single
    commissioner gave little weight to the medical opinions of Drs. Collins, Brawley,
    Salas, and Maddox because they had not been provided Claimant's accurate
    medical history and had based their opinions on Claimant's unreliable self-
    reporting. The single commissioner gave greater weight to Dr. Gualtieri's opinion
    that Claimant was untruthful because it "mirrored" her own impressions and
    "matched the evidence." According to the single commissioner, Dr. Gualtieri "was
    not fooled or manipulated" by Claimant. Over Claimant's objection, the single
    commissioner had admitted the order of Commissioner Barry Lyndon from
    Claimant's prior workers' compensation case. This document was admitted to
    impeach Claimant's deposition testimony regarding whether a deposition, attorney,
    or hearing was involved in that case. In her order, the single commissioner
    indicated she had not relied on Commissioner Lyndon's credibility analysis in
    making her own assessment in the present case.
    Claimant appealed the single commissioner's order raising numerous allegations of
    error, primarily the single commissioner had ignored the great weight of medical
    evidence and relied solely on her credibility assessment to deny the claim. At the
    hearing before the Appellate Panel, Claimant offered the case of Michau v.
    Georgetown, 
    396 S.C. 589
    , 
    723 S.E.2d 805
    (2012), and argued Dr. Gualtieri's
    opinion, which was not stated to a reasonable degree of medical certainty, did not
    qualify as "medical evidence" sufficient to rebut the medical evidence offered by
    Claimant. Respondents acknowledged Dr. Gualtieri's opinion was not so stated.
    The Appellate Panel affirmed the single commissioner, and its order essentially
    adopted the single commissioner's order6 with only a minor deviation. This appeal
    followed.
    STANDARD OF REVIEW
    "In an appeal from the Commission, [the appellate court] . . . may [not] substitute
    its judgment for that of the Commission as to the weight of the evidence on
    questions of fact, but it may reverse when the decision is affected by an error of
    law." Jones v. Harold Arnold's Sentry Buick, Pontiac, 
    376 S.C. 375
    , 378, 
    656 S.E.2d 772
    , 774 (Ct. App. 2008). "Any review of the [C]ommission's factual
    findings is governed by the substantial evidence standard." Lockridge v. Santens of
    Am., Inc., 
    344 S.C. 511
    , 515, 
    544 S.E.2d 842
    , 844 (Ct. App. 2001). "Accordingly,
    we limit review to deciding whether the Commission's decision is supported by
    substantial evidence or is controlled by some error of law." Jones, 376 at 
    378, 656 S.E.2d at 774
    .
    "Substantial evidence is evidence that, in viewing the record as a whole, would
    allow reasonable minds to reach the same conclusion that the full commission
    reached." 
    Lockridge, 344 S.C. at 515
    , 544 S.E.2d at 844. "The 'possibility of
    drawing two inconsistent conclusions from the evidence does not prevent an
    administrative agency's finding from being supported by substantial
    evidence.'" Lee v. Harborside Cafe, 
    350 S.C. 74
    , 78, 
    564 S.E.2d 354
    , 356 (Ct.
    App. 2002) (quoting Palmetto Alliance, Inc. v. S.C. Pub. Serv. Comm'n, 
    282 S.C. 430
    , 432, 
    319 S.E.2d 695
    , 696 (1984)).
    LAW/ANALYSIS
    I.   Medical Evidence—Admission of Dr. Gualtieri's Report
    Claimant contends the Appellate Panel erred in affirming the single
    commissioner's order because the single commissioner relied on the medical
    opinion of Dr. Gualteri, although that opinion was not stated to a reasonable degree
    of medical certainty as required by section 42-9-35 of the South Carolina Code
    6
    The Appellate Panel unanimously affirmed the single commissioner's order and
    stated "the same shall constitute the Decision and Order of the Appellate Panel."
    (2015) and as discussed in Michau v. Georgetown, 
    396 S.C. 589
    , 
    723 S.E.2d 805
    (2012).7 We conclude this issue is not preserved for our review.
    The workers' compensation scheme provides for the manner of review of a single
    commissioner's order. "Either party or both may request Commission review of
    the Hearing Commissioner's decision by filing the original and three copies of a
    Form 30" and "[t]he grounds for appeal must be set out in detail on the Form 30 in
    the form of questions presented." S.C. Code Ann. Regs. 67-701(A)(3) (2012).
    "Each question presented must be concise and concern one finding of fact,
    conclusion of law, or other proposition the appellant believes is in error." S.C.
    Code Ann. Regs. 67-701(A)(3)(a). As to what this requirement means in terms of
    preservation, our courts have said "[o]nly issues raised to the [Appellate Panel]
    within the application for review of the single commissioner's order are preserved
    for review." Hilton v. Flakeboard Am. Ltd., 
    418 S.C. 245
    , 249, 
    791 S.E.2d 719
    ,
    722 (2016). See also Ham v. Mullins Lumber Co., 
    193 S.C. 66
    , 
    7 S.E.2d 712
    (1940) ("[A]ll findings of fact and law by the [single c]ommissioner became and
    are the law of this case, except only those within the scope of the exception of
    defendant and the notice given to the parties by the Commission."). This issue was
    not raised in Claimant's exceptions to the single commissioner's order. 8
    Claimant first raised the Michau argument during her hearing before the Appellate
    Panel. Afterward, when reviewing a draft order denying the claim, Claimant, via
    7
    In Michau, the court concluded a medical opinion offered by the opponent of a
    workers' compensation claim must be stated to a reasonable degree of medical
    certainty.
    Id. at 596, 723
    S.E.2d at 808.
    8
    Claimant argues she raised this issue to the Appellate Panel prior to the hearing
    by stating in her prehearing memo that there was an absence of "competent
    evidence which support[ed] the fact finder's determination [Claimant] did not meet
    her burden of proof." However, "[e]ach issue raised to the Commission must be
    done with specificity, not through blanket general exceptions." 
    Hilton, 418 S.C. at 251
    n.2, 791 S.E.2d at 722 
    n.2. See also Adcox v. Clarkson Bros. Constr. Co., 
    773 S.E.2d 511
    , 516 (N.C. Ct. App. 2015) (noting a claimant's very generalized
    exception to the hearing commissioner's order was "like a hoopskirt—cover[ing]
    everything and touch[ing] nothing"). Furthermore as to Dr. Gualtieri's opinion
    specifically, Claimant alleged only that he created the report prior to meeting
    Claimant, that he used his own diagnostic tests when evaluating Claimant, that he
    was not qualified to evaluate neuropsychological test data, and that his findings do
    not align with Claimant's experts' findings.
    letter, persuaded the Appellate Panel to include a mention of the Michau case and
    section 42-9-35 in its final order. Therefore, Claimant argues the issue was raised
    to and ruled on by the Appellate Panel, and the issue is therefore preserved.
    Indeed, an oft-cited rule of appellate preservation instructs an issue must be raised
    to and ruled upon to be preserved for appellate review. However, other
    requirements for preservation cannot be disregarded. To successfully preserve an
    issue for appellate review, the issue must be: "(1) raised and ruled upon by the trial
    court; (2) raised by the appellant; (3) raised in a timely manner; and (4) raised to
    the trial court with sufficient specificity." S.C. Dep't of Transp. v. First Carolina
    Corp. of S.C., 
    372 S.C. 295
    , 302, 
    641 S.E.2d 903
    , 907 (2007) (quoting Jean Hoefer
    Toal et al., Appellate Practice in South Carolina 57 (2d ed. 2002)). Therefore,
    even if we look to general appellate rules of preservation in deciding this issue, we
    cannot conclude Claimant's argument was "raised in a timely manner." Dr.
    Gualtieri's report was provided to Claimant prior to the hearing before the single
    commissioner and any defect it suffered could have been raised before the hearing
    in front of the Appellate Panel. Consequently, Claimant's point is unpreserved.
    II.   Admissibility of Prior Order
    Claimant also maintains the Appellate Panel erred in affirming the single
    commissioner's order when the single commissioner admitted the prior workers'
    compensation order of Commissioner Lyndon. We disagree.
    Rule 608(b), SCRE, provides:
    Specific instances of the conduct of a witness, for the
    purpose of attacking or supporting the witness'[s]
    credibility, other than conviction of crime as provided in
    Rule 609, may not be proved by extrinsic evidence.
    They may, however, in the discretion of the court, if
    probative of truthfulness or untruthfulness, be inquired
    into on cross-examination of the witness (1) concerning
    the witness'[s] character for truthfulness or
    untruthfulness, or (2) concerning the character for
    truthfulness or untruthfulness of another witness as to
    which character the witness being cross-examined has
    testified.
    In Mizell v. Glover, 
    351 S.C. 392
    , 
    570 S.E.2d 176
    (2002), a medical malpractice
    action, the defendant impeached the plaintiff's expert witness with a jury
    interrogatory from a prior court case in which the expert was found untruthful.
    The supreme court considered whether the introduction of the interrogatory was
    error.
    Essentially, Rule 608(b) allows specific instances of
    conduct to be inquired into on cross, but does not allow
    those instances of conduct to be proved by extrinsic
    evidence. Reading a jury interrogatory into the record is
    more than inquiry into past conduct; the purpose of doing
    so is to prove past conduct. Although [the witness] could
    have been questioned (and was questioned) about the
    conduct that was the subject of the suit, he should not
    have been questioned directly regarding what a previous
    jury allegedly concluded about such conduct.
    Id. at 401, 570
    S.E.2d at 180-81 (omitted parenthetical).
    Additionally, the court found the admission of the interrogatory was not harmless
    because the issue of the expert's credibility was of paramount consideration in the
    case.
    Id. at 401, 570
    S.E.2d at 181.
    In this case, the single commissioner, over Claimant's objection, admitted
    Commissioner Lyndon's order. Respondents maintain this was done to impeach
    Claimant's deposition testimony that she had never been deposed before, she did
    not have an attorney in the prior case, and the prior case did not proceed to a
    hearing. However, extrinsic proof is not permitted under these circumstances and
    Rule 608 and, at the very least, the entire order, which commented on Claimant's
    credibility, was not relevant to impeach as to those specific points. Commissioner
    Lyndon's order calls Claimant's credibility into question at least five times and
    gives little weight to Dr. McQueen's opinion based on inconsistencies and
    contradictions therein. There can be little doubt Respondents offered this evidence
    in an attempt to establish Claimant had been untruthful in a prior workers'
    compensation case and, in conformity therewith, was being dishonest in this case.
    Additionally, the prior order commented on the credibility of Dr. McQueen, a key
    medical provider in the present case. Undoubtedly, the admission of the order was
    erroneous.
    Nevertheless, the admission of the prior order is subject to a harmless error
    analysis. See Muir v. C.R. Bard, Inc., 
    336 S.C. 266
    , 299, 
    519 S.E.2d 583
    , 600 (Ct.
    App. 1999) (subjecting the erroneous admission of letters in a workers'
    compensation case and finding their admission harmless when the information
    contained therein was cumulative of other admissible evidence). The admission of
    this evidence is troubling. It speaks directly to the credibility of Claimant and a
    key medical provider in the case. The single commissioner's credibility findings
    are the foundation of her decision. Nevertheless, the single commissioner indicates
    she did not consider Commissioner Lyndon's credibility findings, and as an officer
    of the court, we give credence to the veracity of that assertion. Additionally and
    importantly, as will be discussed in Section III, other substantial evidence in the
    record supports the single commissioner's credibility determination. Therefore,
    while the admission of the prior order was clearly erroneous, we conclude the error
    was harmless under the particular facts of this case.
    III.   Expert Medical Evidence and Credibility
    Finally, Claimant argues the decision of the single commissioner, and its
    affirmance by the Appellate Panel, was arbitrary and capricious as it was based on
    lay observations and non-medical evidence as opposed to the medical evidence
    presented in the case. We disagree.
    "The final determination of witness credibility and the weight to be accorded
    evidence is reserved for the Appellate Panel." Fishburne v. ATI Sys. Int'l, 
    384 S.C. 76
    , 86, 
    681 S.E.2d 595
    , 600 (Ct. App. 2009). "The Appellate Panel is given
    discretion to weigh and consider all the evidence, both lay and expert, when
    deciding whether causation has been established. Thus, while medical testimony is
    entitled to great respect, the fact finder may disregard it if other competent
    evidence is presented." Potter v. Spartanburg Sch. Dist. 7, 
    395 S.C. 17
    , 23, 
    716 S.E.2d 123
    , 126 (Ct. App. 2011).
    In a case brought under section 42-9-35, the burden is on the claimant to produce
    medical evidence to establish a claim for the exacerbation of a preexisting
    condition. See §42-9-35(A) ("The employee shall establish by a preponderance of
    the evidence, including medical evidence, that: (1) the subsequent injury
    aggravated the preexisting condition or permanent physical impairment . . . .").
    However, this does not require the fact finder to ignore medical evidence that is not
    expert opinion, other lay evidence, or the credibility of the Claimant. In some
    instances the medical evidence and credibility determination can be tidily
    separated. For example, a recent case from the supreme court, Crane v. Raber's
    Disc. Tire Rack, 
    429 S.C. 636
    , 643, 
    842 S.E.2d 349
    , 352 (2020), discussed the
    interplay of credibility determinations and medical evidence in workers'
    compensation cases.
    The commission often makes findings of fact based on
    credibility determinations
    ....
    The reason we consistently affirm these findings derives
    from a principle that applies beyond credibility to all
    factual determinations of the commission: "an award
    must be founded on evidence of sufficient substance to
    afford a reasonable basis for it." When the commission's
    factual determination is "founded on evidence of
    sufficient substance," and the evidence "afford[s] a
    reasonable basis" for the commission's decision in the
    case, the evidence meets the "substantial evidence"
    standard and we are bound by the decision. This point is
    illustrated in the hundreds of cases in which our appellate
    courts have affirmed factual determinations by the
    commission.
    
    Crane, 429 S.C. at 643
    , 842 S.E.2d at 352 (quoting Hutson v. S.C. State Ports
    Auth., 
    399 S.C. 381
    , 387, 
    732 S.E.2d 500
    , 503 (2012)).
    In cases where credibility is not a substantial issue,
    however, even a valid credibility finding is not a proper
    basis for deciding a question of fact. This case illustrates
    that point. Even if [the claimant] was untruthful in his
    testimony at the hearing, his claims for future medical
    care, temporary total disability, and permanent
    impairment caused by hearing loss are based on objective
    medical evidence. The opinions of his treating
    physicians that he suffers from severe to profound
    hearing loss as a result of his work-related accident are
    similarly based on objective medical evidence. There is
    little in [the claimant]'s medical records—or anywhere in
    the record before us—that indicates [the claimant]'s
    credibility reasonably and meaningfully relates to
    whether he actually suffered hearing loss on [the date of
    the incident].
    To make a proper review of a factual determination by
    the commission based on credibility, the appellate court
    must not only understand that the commission relied on
    the credibility finding; the court must also be able to
    understand the reasons the evidence supports the
    credibility finding, and must be able to understand the
    reasons credibility supports the commission's decision.
    In most cases, this is obvious from context.
    Id. at 646-47, 842
    S.E.2d at 354.
    In this case, credibility was a substantial issue because the deterioration in
    Claimant's psychological condition was not objectively measureable like the
    employee's hearing loss in Crane. Therefore, the Appellate Panel could have
    properly given less weight to Claimant's doctor's opinions if it believed Claimant
    was untruthful in her self-reporting of symptoms or her presentation. See Tiller v.
    Nat'l Health Care Ctr. of Sumter, 
    334 S.C. 333
    , 340, 
    513 S.E.2d 843
    , 846 (1999)
    ("Expert medical testimony is designed to aid the Commission in coming to the
    correct conclusion; therefore, the Commission determines the weight and credit to
    be given to the expert testimony."); see also 
    Fishburne, 384 S.C. at 87
    , 681 at 601
    (noting the single commissioner gave less weight to a physician's opinion "because
    of the objective evidence and [her] own observations and impressions at the
    hearing," which included finding the claimant was not credible).
    Although the single commissioner's unforgiving assessment of Claimant's
    credibility was unduly harsh and unwarranted, the record is not without substantial
    evidence that Claimant lacked credibility, even in the absence of Commissioner
    Lyndon's order. In particular, in her deposition, Claimant denied some relatively
    major prior issues entirely. For example, she denied any real neck problems or
    dizziness prior to the accident even though she had complained of both many times
    according to Dr. McQueen's notes and had undergone a CT scan prior to her injury
    for "headaches and dizziness." She characterized her depression as manageable
    and somewhat episodic although Dr. McQueen and/or his nurse practitioner
    characterized it as chronic and major at different times. Claimant appeared to
    downplay the frequency and intensity of prior headaches in spite of McQueen's
    notes indicating she suffered from tension headaches, sinus headaches, and later,
    migraine headaches. With respect to medications, Claimant frequently indicated
    she did not remember whether she was taking a particular medication at a given
    time, although she did not deny taking medicines generally. Her greatest
    misleading statement as to specific medications was that she was only taking
    "something for blood pressure" at the time of her fall when the records reveal she
    had been taking Percocet and Xanax consistently for many years and other
    medications with frequency. The record also demonstrated two occasions in which
    Claimant had been dishonest with providers regarding the filling of her pain
    medications. The single commissioner also relied on her lay observations of
    Claimant's demeanor.
    Claimant's medical records demonstrated a long-standing history of serious
    psychological issues. Additionally, the medical evidence showed Claimant did not
    lose consciousness when she fell and two weeks postfall, she exhibited no "focal
    neurological deficits." Dr. Gualtieri's report also indicated Claimant's injury was
    not the type that should have produced the issues she was suffering and that in his
    opinion, Claimant was malingering.
    In sum, substantial evidence in the record supports the Commission's decision.
    Claimant's medical experts' opinions were substantially weakened in light of the
    credibility findings of the Appellate Panel as the opinions rely, at least in part, on
    an unexaggerated presentation of symptoms. The medical evidence presented by
    Respondents established Claimant had long-standing significant psychological
    issues prior to her workplace fall and the fall itself may not have been the source
    for any deterioration in her condition. Ever mindful of our limited standard of
    review in workers' compensation cases, the order of the Appellate Panel denying
    Claimant's compensation is
    AFFIRMED.
    LOCKEMY, C.J., concurs.
    MCDONALD, J., concurring in result only.