CLAIM NO. E600078
Before the Arkansas Workers’ Compensation Commission
OPINION FILED MAY 25, 2001
Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas.
Claimant represented by the HONORABLE JOHN PURTLE, Attorney at Law, Batesville, Arkansas.
Respondents represented by the HONORABLE RICHARD LUSBY, Attorney at Law, Jonesboro, Arkansas.
Decision of administrative law judge: Affirmed as modified in part and remanded in part.
OPINION AND ORDER
The respondents appeal to the Full Workers’ Compensation Commission an administrative law judge’s opinion filed November 14, 2000. The administrative law judge found, inter alia, that the claimant proved by a preponderance of the evidence that his reactive airway disease was causally related to, arose out of, and/or was a compensable consequence of his compensable injury of July 11, 1995. The administrative law judge found that the claimant proved that the medical treatment sought and received by him after July 11, 1995 was reasonable, necessary, and related to the treatment of his compensable injury. The administrative law judge found that the claimant proved that he was entitled to temporary total disability compensation from September 15, 1995, “through the date of the hearing and continuing through a date yet to be determined.”
After de novo review of the entire record, the Full Commission finds that the claimant proved by a preponderance of the evidence that his reactive airway disease was a compensable consequence of his compensable injury of July 11, 1995. We find that the claimant proved that he was entitled to reasonable and necessary medical treatment related to his compensable injury and compensable consequences thereof. We find that the claimant proved that he was entitled to temporary total disability compensation from September 15, 1995 through December 20, 1996. The Full Commission therefore affirms as modified the opinion of the administrative law judge. In addition, we remand this matter to the administrative law judge for adjudication of the claimant’s entitlement to permanent disability and/or vocational rehabilitation, pursuant to Act 796 of 1993.
I. HISTORY
The parties stipulated that Alfred Raymond Barnett, age 46, sustained a compensable injury on July 11, 1995. Mr. Barnett testified that he smelled a “suffocating odor” on the job site that day and shortly thereafter left the area. The claimant estimated that he was exposed to the odor “about ten minutes.” Dr. Verona T. Brown examined the claimant and entered the following Progress Note on the date of injury:
Mr. Barnett is a gentleman who was involved in a chemical leak at Flour (sic) Daniel. He was on the floor of a non-enclosed structure when there was an apparent leak of croton aldehyde. He complains of his chest feeling tight, slight cough, eyes burning originally and he washed his eyes out and they are not really bothering him now. He had a little nausea and shortness of breath originally which has improved. He was able to move from the building fairly quickly after he noticed there was some sort of chemical leak. Generally he is in good health. . . . He has no history of asthma. . . .
Dr. Brown assessed “Chemical irritation,” the respondents began providing medical treatment, and the claimant returned to work. The record includes a Form AR-N, Employee’s Notice of Injury, signed by Mr. Barnett on July 12, 1995. The employee described the cause of injury as “Chemical venting”, “Chemical name: `Eastman’ Crotonaldehyde.”
A chest x-ray was taken July 17, 1995:
The lungs are well expanded and clear. Heart is not enlarged. Angles are sharp. Bones appear intact.
IMPRESSION: Normal chest.
The claimant said that he began having shortness of breath with physical exertion. “I felt like I was suffocating,” he testified. “And over a period of time, a couple of weeks, I got to where I couldn’t walk right. . . . I was put on light duty during that time somewhere, I can’t remember right when it was, but I couldn’t hold up for any length of time swinging a hammer or carrying even, or walking.”
Dr. Brown assessed “Chemical pneumonitis” on July 17, 1995 and “Chemical inhalation pneumonitis” on July 24, 1995. The impression from a Radiographic Report done August 4, 1995, however, was “Normal chest with no interval change.” Dr. Brown reported on August 28, 1995:
Mr. Barnett is here today with Frank McComas for follow up. I think we have evaluated Mr. Barnett quite thoroughly, from a pulmonary stand point. He saw Jeff Cohen, a pulmonologist in Jonesboro, who did a methacholine challenge. I don’t have a definite report from Dr. Cohen as of yet, however a verbal report was that he had no reactive airway disease noted. He continues, however, to complain of “weakness at times especially with exertion”, shortness of breath and also this vague pain in his legs which I have no explanation for. I have discussed this in great detail with Frank, as well as Mr. Barnett, and have no reservation to send him elsewhere for further evaluation as he seems fairly insistent that he would like to pursue this further. From a pulmonary stand point I feel we have exhausted the evaluation. Frank is going to get with the workmen’s comp carrier to see if they have any industrial medicine specialists that we could consult with and get back to me. In the meantime, they are going to leave Mr. Barnett at a lighter than usual activity level and see if he gradually increases his tolerance with a little more time.
Dr. Jeffrey O. Cohen, a pulmonary medicine specialist, wrote to Dr. Brown on August 29, 1995:
I have completed my evaluation of Raymond Barnett.
This evaluation consisted of a complete history and physical examination, exercise pulse oximetry and methacoline challenge testing. I do not find evidence of specific pathology in Mr. Barnett. His methacoline challenge testing was normal and he gave a good and consistent effort on this test. He did have tachycardia and mild desaturation with exercise pulse oximetry, however, this is consistent with deconditioning and he had a rapid recovery.
In short, I do not find evidence for specific occupational lung disease, consistent with that induced by crotonaldehyde exposure. I have initiated a literature search to look at recent information on crotonaldehyde in addition to the forms you sent with Mr. Barnett. I will forward to you the results of this search when I receive it. Otherwise, I have no specific suggestions.
Dr. Cohen indicated in a post script that “Search did not turn anything up. I’ve enclosed a copy.” The respondents controverted additional medical treatment after August 29, 1995. The claimant testified that he continued to try to work and said he in fact “passed out” on the job on September 7, 1995.
The claimant began treating on his own with an internal medicine specialist, Dr. Robert H. Hopkins, on September 11, 1995. Dr. Hopkins’ impression was “Reactive airway disease without specific known etiology, although the time frame appears that this at least was incited by his exposure to chemical fumes while on the job in July.”
The record indicates that the respondents terminated the claimant’s employment on or about September 14, 1995. The claimant testified that he had been instructed to install a motor in the respondents’ operations area, where the claimant knew chemicals were mixed. The claimant asked his supervisor to direct another employee to work in the operations area, because the claimant would not be able to breathe. The respondents terminated the claimant that day for refusing to perform the assigned job, for not reporting to an appointment with the company doctor, and for presenting to his own doctor. The claimant testified that he has not worked since September 14, 1995.
Dr. Hopkins reported on December 4, 1995:
Mr. Barnett is a 41 year old gentleman who returns today for a followup of his reactive airway disease. He is currently maintained on Proventil two puffs b.i.d. p.r.n. wheezing, Aerobid two puffs t.i.d. and Tilade two puffs t.i.d. He was last here approximately two months ago and states in general his exercise tolerance continues to improve somewhat, although he does have episodes of wheezing and shortness of breath. He states he has mostly noticed these when he is around women and men who are using colognes, perfumes, and hair sprays, or when he over exerts himself although cold air exposure does tend to make him somewhat tighter. He states otherwise he has been doing fairly well. . . . His lungs are clear with good air movement throughout. . . .
IMPRESSION: Reactive airways disease — stable with continued episodes of reactivity particularly in response to irritants and potential allergens.
Dr. Hopkins planned continued treatment for the claimant’s symptoms, and wrote to the claimant on December 7, 1995:
I have been seeing you in the UPMG Clinic at the University of Arkansas for Medical Sciences since the 11th of September this year. The history, physical exam, and laboratory evaluations that we have obtained since that time are consistent with your development of reactive airways disease. As we have discussed, reactive airways disease is a term that we use now for what was often called asthma in the past. I hesitate to use the term asthma at the current time, because we do not know if your symptoms will continue for any particular length of time or whether they will resolve over the next few weeks or months. The history that I obtained does reveal that it appears your episodes of shortness of breath and chest pain from that began in July after exposure to some irritants on the job. There is no way for me to determine exactly whether this irritant exposure or other basis is the cause of your reactive airways disease. Although your symptoms began after the exposure in mid-July, there is no way for me to say exactly or specifically that that is what caused your symptoms since I did not see you until September. There is no way to objectively verify or disprove this that I know of. Reactive airways disease may be caused by multiple different mechanisms. It may be inherited, it may occur as a result of irritant or allergic exposure, or it may be caused by changes that can occur from smoking or other toxins in the lung. We are often unable to determine the specific cause of someone developing reactive airways disease in their adult life.
It certainly does appear that your symptoms of shortness of breath and chest pain have improved somewhat on your current medication regimen of Aerobid two puffs via the air chamber three times a day, Tilade two puffs three times a day via the air chamber, and Proventil as needed. However, you certainly by history do not have the normal exercise tolerance you had prior to the onset of these symptoms. We have begun you on Claritin 10 mg once a day to attempt to blunt any possible allergic cause of some of your recent flareups of shortness of breath.
The claimant began treating with Dr. Aubrey M. Worrell, an allergist-immunologist, on July 30, 1996:
Mr. Barnett was essentially well until exposure to Crotonaldehyde Vapor while on his job on July 11, 1995. Previous to that episode, he had only infrequently made visits to his physicians for any type of illness. . . .
On review of the MSDS Sheets on Crotonaldehyde, the fumes to which he is exposed, states it is a very strong irritant and can cause severe eye and skin burns and is a sensitizer in some individuals, leading to allergic contact dermatitis. Certainly, if a chemical can cause sensitization, it can do it also in the lungs, leading to chemical pneumonitis, as previously diagnosed, and also sensitization leading to asthma, wheezing and shortness of breath and other upper respiratory symptoms. . . .
He presently has breathing problems everyday with wheezing and [sic] will especially will [sic] occur on exposure to any type of ambient chemicals, such as gas and household fumes, farm crop chemicals, industrial air pollution, household chemicals, aerosols and sprays, waxes, polishes, detergents, paints, solvents, butane, alcohol, candles, Lysol, new car odors, Purex, Clorox, new carpets and drapes and a visit to department stores, grocery stores, movies and churches. . . .
IMPRESSION:
1) Toxic response to exposure to Crotonaldehyde Vapors while at work with subsequent development of sensitization to many environmental chemicals and other agents.
2) Multiple Chemical Sensitivities, secondary to diagnosis #1. Diagnosis #1 and #2 have led to the following diagnoses:
3) Occupational induced asthma with reactive airway disease.
4) Chronic Fatigue.
5) Gastrointestinal Indigestion, Gas and Bloating and Diarrhea.
6) Cognitive Dysfunction.
7) Myalgia.
8) Headaches.
It is my opinion that the patients (sic) above diagnoses and health problems are related to and caused by his exposure to Crotonaldehyde on July 11, 1995, and this opinion is given with reasonable medical certainty.
Dr. Worrell prescribed a number of different inhalers, instructed the claimant on avoidance of chemicals, and started a “Chemical Free Diet” for the claimant. The parties deposed Dr. Worrell on September 5, 1996, who again opined, “all of his health problems are related to his exposure to the Crotonaldehyde.”
Dr. Worrell reported on December 20, 1996:
Enclosed are copies of the enclosed laboratory testing and it does show that you have some abnormalities in your energy production, detoxication and neurotransmitter metabolism. There is also some deficiencies in minerals, including Chromium and Magnesium. The antioxidant enzymes, show some abnormalities, also, indicating mineral deficiency.
I would like to add several nutritional supplements to your previous nutritional supplements. . . . It is going to take several months for you to notice significant improvement, but hopefully you will notice slow improvement in many of your symptoms.
Mr. Barnett claimed entitlement to additional worker’s compensation. The claimant contended that “he is unable to work because of an industrial accident which to date has rendered him unable to work.” The respondents contended that “claimant’s current physical problems, if any, are not related to his minor compensable injury. In addition thereto, claimant has been requested by previous administrative law judges to provide up to date medical information regarding his claim and to date the most recent medical information is from some years back. Furthermore, claimant claims to have sought unauthorized treatment from an unknown physician. If claimant is asking for those medical benefits then they should be denied as being unauthorized.” The Pre-HearingOrder set forth the following issues for litigation:
1. Compensability/causal relationship of claimant’s current complaints.
2. Temporary total disability.
3. Permanent disability.
4. Additional medical benefits.
5. Rehabilitative benefits.
6. Attorney’s fees.
After a hearing before the Commission, the administrative law judge found that the evidence “proves a causal relationship between Claimant’s compensable injury and his current need for treatment.” The administrative law judge found that the “claim for permanent disability benefits is premature because he remains within his healing period, and is, accordingly, not yet ripe for determination.” With regard to temporary disability, the administrative law judge found:
Claimant was physically disabled and unable to continue in his employment and has remained totally incapacitated from earning wages since September 14, 1995; according to Dr. Aubrey Worrell, Claimant remains within his healing period, and is therefore entitled to temporary total disability benefits from September 15, 1995, through the date of the hearing and continuing through a date yet to be determined.
The administrative law judge therefore found that the claimant proved that his reactive airway disease was causally related to the July 11, 1995 compensable injury, and that the compensable injury was the “major cause” of the claimant’s reactive airway disease. The administrative law judge found that “The record in this cause contains no form AR-N, and the Claimant is not bound by authorized treatment restrictions.” The administrative law judge found that the claimant “is temporarily and totally disabled and remains within his healing period, and is entitled to appropriate benefits from September 15, 1995, through the date of the hearing and continuing through a date yet to be determined.” The administrative law judge ordered the respondents to pay “all reasonable and necessary medical expenses related to Claimant’s compensable injury of July 11, 1995.” The respondents appeal to the Full Commission.
II. ADJUDICATION
A. Causal connection
When an injury arises out of and in the course of employment, the original employer or carrier is responsible for every natural consequence that flows from the injury. McDonald Equipment Co. v. Turner, 26 Ark. App. 264, 766 S.W.2d 936 (1989). When subsequent complications are the natural and probable result of the original injury, the employer remains liable. The basic test is whether there is a causal connection between the two episodes. Bearden Lumber Co. v. Bond, 7 Ark. App. 65, 644 S.W.2d 321 (1983). Causal connection is generally a matter of inference, and possibilities may play a proper and important role in establishing that relationship. Osmose Wood Preserving v. Jones, 40 Ark. App. 190, 843 S.W.2d 875 (1992). The determination of whether a causal connection exists is a question of fact for the Commission.Carter v. Flintrol, Inc., 19 Ark. App. 317, 720 S.W.2d 337 (1986).
In the present matter, the Full Commission finds that the claimant’s reactive airways disease, viz., asthma and attendant complications, was a natural and probable result of his original compensable injury. The claimant credibly testified that he did not experience significant health problems prior to the compensable injury. There is no evidence of record showing that the claimant ever suffered from asthma or other breathing difficulties prior to his July 11, 1995 workplace exposure to crotonaldehyde. A physician assessed “chemical irritation” on the date of the compensable injury, and the claimant has suffered significantly since that time. Nevertheless, the respondents controverted additional medical treatment after August 29, 1995. An internal medicine specialist, Dr. Hopkins, saw the claimant in September, 1995 and assessed “Reactive airway disease without specific known etiology, although the time frame appears that this at least was incited by his exposure to chemical fumes while on the job in July.”
The claimant began treating with Dr. Worrell in July, 1996. TheDissenting Opinion states that Dr. Worrell practices “nutritional biochemistry” and “clinical ecology.” Actually, the record indicates that Dr. Worrell has practiced allergy-immunology since 1973, subsequent to his training at the University of Arkansas School of Medicine and licensing by the Arkansas State Medical Board. Dr. Worrell did begin additional practices of environmental medicine in 1980 and nutritional biochemistry in 1984. The Dissenting Opinion cites Barrett v. C.T.S. ofBentonville, Workers’ Compensation Commission D502632 (March 14, 1988) for the proposition that the fields of environmental medicine and nutritional biochemistry are “experimental and unproven.” Whether or not this so is not probative in determining whether the claimant proved entitlement to additional worker’s compensation for his compensable injury. There is otherwise no indication of record that Dr. Worrell is not properly licensed by the State of Arkansas to examine and treat patients.
The Dissenting Opinion also cites a number of cases purporting to indicate that the Commission “has declined to accept Dr. Worrell’s views.” The cases cited by the Dissenting Opinion are readily distinguishable from the present matter. For instance, in Owens v.Robbins, Inc., Workers’ Compensation Commission E310171 (Feb. 27, 1997), there were conflicting medical opinions on causation, and the Commission determined that Dr. Worrell had not explained the basis for his opinion. In Harris v. Central Arkansas Maintenance, Workers’ Compensation Commission E105366 (April 19, 1993) and Still v. Franklin Electric, Workers’ Compensation Commission D713806 (Nov. 21, 1989), the Commission determined that Dr. Worrell’s opinion was based solely on the claimant’s histories.
Further, there are cases where the Commission and Arkansas Court of Appeals have relied on Dr. Worrell’s findings with regard to causation.See, Nelson v. Georgia-Pacific Corporation, Workers’ Compensation Commission E612459 (April 27, 1999); General Industries v. Gibson, 22 Ark. App. 217, 738 S.W.2d 104 (1987). From the record currently before the Commission, the preponderance of credible evidence support’s Dr. Worrell’s statement that the claimant “was essentially well until exposure to Crotonaldehyde while on his job on July 11, 1995.” Dr. Worrell’s impression was “Occupational induced asthma with reactive airway disease.” Dr. Worrell opined that the claimant’s health problems “are related to and caused by his exposure to Crotonaldehyde on July 11, 1995, and this opinion is given within reasonable medical certainty.” Dr. Worrell reiterated his opinion at a deposition taken September 5, 1996. There are no conflicting medical opinions on causation, as there were in Owens, supra. Nor was Dr. Worrell’s opinion based solely on the claimant’s history, as in Harris and Still, supra. We recognize that Dr. Cohen was unable to find evidence for “specific occupational lung disease,” although Dr. Cohen did not specifically opine regarding causation of the claimant’s reactive airways disease. Dr. Hopkins, an internal medicine specialist not associated with Dr. Worrell, subsequently diagnosed reactive airways disease and noted that the compensable injury incited the claimant’s condition.
The Full Commission therefore affirms the administrative law judge’s determination that the claimant’s “reactive airway disease is causally related to, arose out of, and/or is a compensable consequence of his compensable injury of July 11, 1995.” The Commission is authorized to accept or reject medical opinion, and we are authorized to determine its medical soundness and probative force. McClain v. Texaco, Inc., 29 Ark. App. 218, 780 S.W.2d 34 (1989). The instant claimant credibly testified that he did not experience breathing problems prior to his compensable injury, and the preponderance of evidence corroborates his testimony. We also note the independent opinion of Dr. Hopkins, an internal medicine specialist, who stated that the claimant’s problems began after his workplace injury. From the record before us, therefore, the Commission finds that Dr. Worrell’s opinions on causation are medically sound and entitled to significant weight. In this regard, the Full Commission expressly accepts Dr. Worrell’s opinion that the “proximate cause” of the claimant’s health problems was “the chemical exposure to Crotonaldehyde” on July 11, 1995.
The respondents contend that not “a single objective test finding” corroborates Dr. Worrell’s impression of “Occupational induced asthma with reactive airway disease.”
We recognize that the Commission has previously determined that a finding of a compensable consequence must be supported by objective medical findings. See, Barnes v. Alma School District, Workers’ Compensation Commission E711749 E905201 (July 3, 2000), citing Cooperv. City of Fouke, Workers’ Compensation Commission E807244 (Oct. 14, 1999). The Commission may have erred as a matter of law in requiring that a finding of a compensable consequence be supported by objective medical evidence. See, Concurring Opinion, Rivera v. Shelby Group, Workers’ Compensation Commission E605465 (Jan. 8, 2001).
In any event, the instant record yields a number of objective findings in determining whether the claimant’s reactive airways disease was a compensable consequence of his compensable injury. Dr. Worrell testified:
Q. Now when you examined Raymond Barnett, did you perform any tests on Raymond?
A. Yes, we did some tests. One of the test (sic) is not back. There were a lot of other tests that we couldn’t do, or rather we elected not to do at that time, because I thought we had some time in the future to do them. We did a urinalysis, and the urinalysis shows an acid urine, which is often seen in patients who are fighting chemicals that has (sic) gone into the body. Of course, acid urine can be caused by other things too.
Q. What are some of the — let me ask you real quickly — what are some of the other things that can cause this acid?
A. Well, sometimes some dietary things, you know, eating certain foods sometimes can cause an acid urine, or drinking a lot of Cokes and soft drinks can do it.
Q. What else did the tests show you?
A. He had increased cholesterol and increased triglycerides. That’s seen in a lot of patients, but one of the causes of increased cholesterol and triglycerides is when you’re exposed to chemicals and there is damage to nerves or your neurological system in that the body increases its cholesterol and triglycerides as a response to help in healing nerves, membranes and nerves. So that could be related there. On the blood count, he has an increase in polymorphonuclear cytes and somewhat a decrease in lymphocytes, but that indicates an acute response to an inflammatory reaction. . . .
Q. . . . what has caused the abnormal blood pressure?
A. I think it goes along with all the other type health reactions that he’s had, and certainly the cardiovascular system is one target of chemicals, what we call xenobiotics, and you can become sensitized in your cardiovascular system just like you can in your lungs or your skin. And one thing that you would see would be elevated blood pressure.
The Full Commission finds that the above factors testified to by Dr. Worrell, including acid urine, increased cholesterol, increased triglycerides, increased polymorphonuclear cytes, decreased lymphocytes, and abnormal blood pressure, are all objective medical findings beyond the claimant’s voluntary control. See, Ark. Code Ann. § 11-9-102(16)(a)(i) (Supp. 1999). These objective findings distinguish the present matter from Morris v. American Transportation, Workers’ Compensation Commission D610939 (May 8, 1989), a case cited by the Dissenting Opinion in an effort to impugn Dr. Worrell’s findings on causation. In Morris, there were no abnormalities shown from diagnostic testing conducted by Dr. Worrell. We therefore find that the claimant proved by a preponderance of the evidence that his reactive airways disease was a compensable consequence of his admittedly-compensable injury, and that his compensable consequence was established by objective medical evidence beyond the claimant’s voluntary control.
B. Medical treatment
The administrative law judge found “That the record in this cause contains no Form AR-N, and the Claimant is not bound by authorized treatment restrictions.” The administrative law judge factually erred, in that a Form AR-N is included of record at Respondents’ Exhibit No. 2. It is sufficient for Form AR-N to be provided to a claimant in order to bring the change of physician rules into play. Decker v. Lowe’s, Workers’ Compensation Commission E102455 (June 5, 1992). However, the respondents controverted additional medical treatment after August 29, 1995. The change of physician rules do not apply during a controverted period.Clements v. Shoneys, Workers’ Compensation Commission E604632 (Feb. 12, 1998). Therefore, the Full Commission nevertheless affirms the administrative law judge’s finding that the claimant was not bound by “authorized treatment restrictions.” We find that the claimant proved that he was entitled to reasonable, necessary, and related medical treatment after August 29, 1995, including that treatment and/or referrals provided by Dr. Hopkins and Dr. Worrell.
C. Temporary disability
Temporary disability is determined by the extent to which a compensable injury has affected the claimant’s ability to earn a livelihood. An injured employee is entitled to temporary total disability compensation during the period of time that he is within his healing period and totally incapacitated to earn wages. Arkansas State Highway andTransportation Department v. Breshears, 272 Ark. 244, 613 S.W.2d 392
(1981). Ark. Code Ann. § 11-9-102(12) (Supp. 1999) defines “healing period” as the period necessary for the healing of an injury resulting from an accident. The healing period continues until the claimant is as far restored as the permanent character of his injury will permit. When the underlying condition causing the disability becomes stable, and when nothing further will improve that condition, the healing period has ended. The claimant is no longer entitled to receive temporary total disability compensation, regardless of his physical capabilities.
In the present matter, the claimant sustained a compensable injury on July 11, 1995. The claimant’s treating physicians subsequently diagnosed “reactive airway disease,” which condition we have determined supra to be a compensable consequence of the claimant’s compensable injury. After the respondents had controverted additional medical treatment for the claimant’s compensable condition, and while he was suffering from the effects of same, the respondents instructed the claimant to work in a chemical-mixing area. The claimant asked not to work in that area, because he would not be able to breathe. The respondents terminated the claimant on September 14, 1995. The reasons given were (1) refusing to perform his assigned work; (2) not reporting for an appointment with the company doctor; and (3) presenting to his own doctor. Although the respondent-employer asserted that the claimant was terminated for “insubordination,” the preponderance of evidence indicates that the claimant was unable to perform his work duties because of the compensable injury. The Full Commission finds that the claimant was within his healing period and totally incapacitated to earn wages as of September 15, 1995.
After being let go by the respondents, the claimant continued to treat for reactive airways disease with Dr. Hopkins. The claimant began reasonably necessary medical treatment with Dr. Worrell in July, 1996. Dr. Worrell’s last report was entered on December 20, 1996, at which time Dr. Worrell opined that the claimant’s symptoms would improve. However, Dr. Worrell’s December 20, 1996 medical report is the last medical report in the record from which we could base a determination that the claimant remained in his healing period for any period after December 20, 1996 and continuing through the date of the hearing held on October 11, 2000, nearly four years later. Consequently, the Full Commission finds that the claimant was within his healing period and totally incapacitated to earn wages from September 15, 1995 through December 20, 1996, but that the claimant failed to prove by a preponderance of the evidence that he remained within his healing period after December 20, 1996. Therefore, we find that the administrative law judge’s decision in this regard must be modified.
D. Permanent disability
Having determined that the claimant remained within his healing period and entitled to temporary total disability compensation to a date yet to be decided, the administrative law judge found that “the claimant’s claim for permanent disability benefits is not yet ripe for determination; accordingly, Claimant is likewise not yet eligible for benefits pursuant to Ark. Code Ann. § 11-9-505(b).”
The Full Commission has determined supra that the claimant has failed to establish that he is entitled to any additional period of temporary disability compensation after December 20, 1996. Therefore, we find that the claimant’s entitlement to permanent disability and/or vocational rehabilitation is ripe for determination. We remand to the administrative law judge for appropriate findings regarding the claimant’s entitlement to permanent disability and/or vocational rehabilitation in accordance with Act 796 of 1993.
III. CONCLUSION
Based on our de novo review of the entire record, the Full Commission finds that the claimant proved by a preponderance of the evidence that his reactive airways disease was a compensable consequence of his compensable injury of July 11, 1995. We find that the claimant proved that he was entitled to reasonable and necessary medical treatment related to his compensable injury, specifically treatment and/or referrals provided by Dr. Hopkins and Dr. Worrell. We find that the claimant proved that he was entitled to temporary total disability compensation from September 15, 1995 through December 20, 1996. The Full Commission therefore affirms, as modified, the opinion of the administrative law judge. The Full Commission remands this matter to the administrative law judge for adjudication of the claimant’s entitlement to permanent disability and/or vocational rehabilitation, pursuant to the provisions of Act 796 of 1993.
All accrued benefits shall be paid in a lump sum without discount and with interest thereon at the lawful rate from the date of the administrative law judge’s decision in accordance with Ark. Code Ann. §11-9-809 (Repl. 1996).
For prevailing in part on this appeal before the Full Commission, claimant’s attorney is hereby awarded an additional attorney’s fee in the amount of $250.00 in accordance with Ark. Code Ann. § 11-9-715 (Repl. 1996).
IT IS SO ORDERED.
________________________________ ELDON F. COFFMAN, Chairman
________________________________ SHELBY W. TURNER, Commissioner
Commissioner Wilson dissents.
DISSENTING OPINION MIKE WILSON, Commissioner.
I respectfully dissent from the majority’s opinion finding that the claimant’s reactive airway disease was a compensable consequence of the claimant’s July 11, 1995 injury. Based upon my de novo review of the record, I find that the claimant has failed to meet his burden of proof.
In finding that the claimant’s reactive airway disease is a compensable consequence of his July 11, 1995 injury, the majority relies on the opinions of Dr. Aubrey Worrell. The majority found that Dr. Worrell’s opinions on causation were medically sound and entitled to significant weight. In my opinion, Dr. Worrell’s opinions are entitled to little if no weight.
On more than one occasion, this Commission has found that the opinions of Dr. Worrell were entitled to little if any weight. Dr. Worrell practices “nutritional biochemistry” and “clinical ecology,” which are fields that are “experimental and unproven.” Janice Barrett v. C.T.S. ofBentonville, Full Commission Opinion filed March 14, 1988 (W.C.C. D502632). There are a number of cases that Dr. Worrell has given an “expert opinion,” and this Commission has declined to accept Dr. Worrell’s views. See Glenda Harris v. Central Arkansas Maintenance, Full Commission Opinion filed April 19, 1993 (W.C.C. E105366), Terry Graciev. Central Maloney, Full Commission Opinion filed July 20, 1994 (W.C.C. E214965), Margaret Lemons v. J E Enterprises, Full Commission Opinion filed April 12, 1995 (W.C.C. E215847), and Carlton Owens v. Robbins,Inc., Full Commission Opinion filed February 27, 1997 (W.C.C. E310171).See also Steve Steel v. Franklin Electric, Full Commission Opinion filed November 21, 1989 (W.C.C. D713806), Ralph Morris v. AmericanTransportation, Full Commission Opinion filed May 8, 1989 (W.C.C. D610939).
The medical evidence in this case shows that Dr. Worrell based his opinion on his one-time examination of the claimant. After examining the claimant one time in July of 1996, Dr. Worrell diagnosed the claimant as suffering from multiple chemical sensitivities and occupational-induced asthma with reactive airway disease. He also found that the claimant suffered from chronic fatigue, gastrointestinal problems, cognitive dysfunction, myalgia, and headaches. There was no testing done to determine what, if anything, the claimant had become specifically allergic to after his exposure to the Crotonaldehyde. Dr. Worrell conceded that he simply took the claimant’s word for it. His diagnosis is clearly based upon the history that the claimant gave to him. A medical opinion based solely upon claimant’s history and own subjective belief that a medical condition is related to a compensable injury is not a substitute for credible evidence. Brewer v. Paragould HousingAuthority, Full Commission Opinion filed Jan. 22, 1996 (E417617). The commission is not bound by a doctor’s opinion which is based largely on facts related to him by claimant where there is no sufficient independent knowledge upon which to corroborate claimant’s claim. Roberts v.Leo-Levi Hospital, 8 Ark. App. 184, 649 S.W.2d 402 (1983).
It is interesting to note that the claimant suffered no adverse reaction when exposed to chemicals and other irritants at Dr. Cohen’s office five weeks after the industrial accident.
The nature and extent of the claimant’s actual exposure to the chemical causes me to question the veracity and credibility of the claimant’s complaints and the diagnosis of Dr. Worrell. That credibility is further undermined by the findings in the initial exams undergone by the claimant following the incident. Dr. Brown’s office note dated July 7, 1995, reflects that the claimant’s chest was clear. The July 17, 1995 examination reflected “light crackles” but good air movement into the claimant’s lungs. An x-ray taken on that date showed the claimant’s lungs to be well-expanded and clear. A follow-up examination on July 24, 1995 showed that there was again good air movement with “no wheezing.” Additional follow-up visits on August 4, August 7, and August 11 reflect that the claimant’s chest was clear, there was good air movement, and that his pulmonary functions were unremarkable.
Despite ongoing test results and examinations that were essentially normal, the claimant was referred to a pulmonary specialist, Dr. Jeffrey Cohen. On August 16, 1995, Dr. Cohen indicated in a report that his examination determined that the claimant’s lungs were “absolutely clear.” Dr. Cohen speculated that perhaps there was some disease based on the claimant’s ongoing complaints. Dr. Cohen noted:
. . . however, I do not see any evidence from the rather extensive data already collected before my physical examination. It is possible that he could have occupational asthma or rather reactive airway dysfunction syndrome from the inhabitation, however, it seems unlikely because he was not in an enclosed place at the time of the inhalation.
Dr. Cohen conducted spirometries to measure the claimant’s pulmonary function. The baseline spirometry was “completely normal” and the “Methacholin challenge testing” that was done to reproduce sensitive reaction yielded a negative response. Dr. Cohen wrote on August 29, 1995:
I have completed my evaluation of Raymond Barnett. This evaluation consisted of a complete history and physical examination, exercise pulse oximetry, and Methacholin challenge testing. I do not find evidence of specific pathology in Mr. Barnett. His Methacholin challenge testing was normal and he gave a good and consistent effort on this test. He did have tachycardia and mild desaturation with exercise pulse oximetry, however, this is consistent with deconditioning, and he had a rapid recovery.
In short, I do not find evidence for specific occupational lung disease, consistent with that induced by Crotonaldehyde exposure. I have initiated a literature search to look at recent information on Crotonaldehyde in addition to the forms that you sent with Mr. Barnett. I will forward to you the results of the search when I receive it. Otherwise, I have no specific suggestions.
When I consider the evidence that the claimant’s examinations were all normal and all his testing was normal after the exposure to Crotonaldehyde, I find that Dr. Cohen’s medical opinion is entitled to more weight than Dr. Worrell who has only examined the claimant one time and has conducted no further testing. Therefore, I respectfully dissent from the majority’s opinion.
_______________________________ MIKE WILSON, Commissioner