CLAIM NO. D717042
Before the Arkansas Workers’ Compensation Commission
OPINION FILED FEBRUARY 2, 1999
Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas.
Claimant represented by the HONORABLE DENVER L THORNTON, Attorney at Law, El Dorado, Arkansas.
Respondents represented by the HONORABLE BRIAN H. RATCLIFF, Attorney at Law, El Dorado, Arkansas.
Decision of Administrative Law Judge: Affirmed.
[1] OPINION AND ORDER[2] The claimant appeals an administrative law judge’s opinion filed July 8, 1998. The administrative law judge found that the claimant failed to prove that she is entitled to additional medical treatment as a result of her compensable back injury of October 9, 1987. After reviewing the entire record de novo, we affirm the decision of the administrative law judge. [3] The parties stipulated that the claimant, age 50, sustained a compensable injury to her back on October 9, 1987. Dr. J. E. Seale, the company physician, referred the claimant to Dr. Ernest Hartmann, an orthopedic surgeon. Dr. Hartmann diagnosed acute lumbar disc strain and treated the claimant conservatively. Said treatment included a continuing prescription of Soma and Vicodan. On February 11, 1988, Dr. Hartmann released the claimant to return to work and instructed her to avoid heavy lifting. On February 16, 1988, Dr. Hartmann referred the claimant to a neurosurgeon, Dr. John Adametz. According to Dr. Hartmann, Dr. Adametz thought that surgery was necessary, but the claimant was afraid of undergoing surgery. Dr. Hartmann thus continued conservative management. On September 1, 1988, Dr. Hartmann referred the claimant back to Dr. Adametz for reconsideration of surgery. On September 8, 1988, Dr. Adametz wrote:
[4] In December, 1988, Dr. Adametz stated that the claimant had lost a sufficient amount of weight so that he could safely perform surgery. Dr. Adametz carried out a lumbar laminectomy at L4-5 on the right on January 10, 1989. The surgery was successful, although the claimant continued feeling pain in her back and right leg. In April, 1989, Dr. Adametz felt that the claimant was experiencing an acute sacroiliac joint strain. Dr. Adametz placed the claimant on Medrol, and he performed a right sacroiliac joint injection in May, 1989. Dr. Adametz wrote to Dr. Hartmann on July 20, 1989:This lady is markedly obese. Her weight at the time of this examination was 233 lbs. I have explained to her that I do not feel surgery would be of any benefit to her if she is not able to lose any weight first. I have advised her to get on a weight reduction program and if she can lose 45 lbs. then I would consider surgery on her. She is to contact my office when she has lost this amount of weight.
[5] The Commission subsequently found that the claimant was entitled to 35% wage loss, for a total disability rating of 50%. [6] Dr. Steven Cathey saw the claimant on March 11, 1993:I feel this lady has reached maximum benefit from medical care. Her postop CT scan shows no evidence of any recurrent disc. No manner of medication has been of much benefit to her, but she feels that if she doesn’t take the medication then her symptoms are greater. I have released her from my care as of July 20, with a 15% permanent partial disability to the body as a whole. She was not given any specific return time to this office. I have asked her to contact your office if she should need additional treatment.
[7] Dr. Cathey’s impression was degenerative lumbar disc disease with associated osteoarthritis. He stated:Mrs. Benton is a 45 year old black female referred by Dr. James Seale for evaluation of multiple somatic complaints. Her prime concern, however, is discomfort in the lower lumbar area with occasional radiation to the left leg. The patient had back surgery in 1989 for an apparent L4/L5 disc herniation on the right side.
Unfortunately, the patient did not identify any meaningful benefit from the surgery. In addition to her back and left leg pain, the patient is experiencing some generalized discomfort in the left shoulder, arm, neck, head, etc.
The patient’s neurological exam is entirely negative. She specifically has no evidence of lumbar radiculopathy, cervical myeloradiculopathy, etc. She is wearing a rigid lumbosacral corset for support. She is morbidly obese weighing in at 226 lbs. The patient does not put forth a very good effort with range of motion testing and seems to move with an exaggerated degree of caution and deliberation.
[8] On March 29, 1993, Dr. Cathey reported:The patient has a long history of Soma and Darvocet use but has not taken any of the medication in the past two months. Dr. Hartman (sic), her orthopedist in El Dorado, has apparently retired and she has lost her source. Although she has requested renewal of this medication, I have indicated that it is not appropriate to continue these drugs for non-malignant pain. The patient will therefore remain on aspirin, Advil or other nonsteroidal anti-inflammatory medications.
[9] Dr. Seale, the company physician, referred the claimant to Dr. Wilbur Giles in February, 1994. On February 17, 1994, Dr. Giles stated that there was nothing he could offer the claimant from a neurosurgical standpoint. Dr. Giles thought that an anterior lumbar fusion might benefit the claimant, but he wished for Dr. Saer to enter an opinion on the matter. The claimant returned to Dr. Cathey in September, 1994. Dr. Cathey noted that Dr. Seale had requested a second opinion from Dr. Ed Saer; however, the carrier wished for the claimant to return to Dr. Cathey. On September 19, 1994, Dr. Cathey stated that the claimant’s “neurological exam remains entirely negative.” Dr. Cathey saw some “hysterical signs” and noted that the claimant remained “morbidly obese.” There was no evidence of recurrent disc herniation. [10] The administrative law judge stated that the claimant continued to treat periodically with her physicians even after having reached maximum medical improvement. The administrative law judge found that the claimant was provided no treatment with these doctor visits, but instead obtained prescriptions for additional medicine. The administrative law judge thus found that the claimant failed to prove, by a preponderance of the evidence, that she is entitled to any additional medical treatment as a result of her compensable back injury. Claimant appeals to the Full Commission, contending that she is entitled to additional medication and treatment for her injury. [11] Ark. Code Ann. § 11-9-508 (Repl. 1987) provides that the employer shall promptly provide for an injured employee such medical, surgical, hospital, and nursing service, and medicine . . . as may be reasonably necessary for the treatment of the injury received by the employee. What constitutes reasonable and necessary medical treatment under this section is a fact question for the Commission. Wright Contracting Co. v.Randall, 12 Ark. App. 358, 676 S.W.2d 750 (1984). [12] We affirm the decision of the administrative law judge. Dr. Hartmann diagnosed an acute lumbar disc strain in 1987, for which the claimant initially underwent conservative treatment. Dr. Adametz performed a lumbar laminectomy in January, 1989. On July 20, 1989, Dr. Adametz opined that the claimant had reached maximum benefit from medical care. Nearly four years later, in 1993, Dr. Cathey’s neurological examination of the claimant was entirely negative. There was no sign of recurrent disc herniation. Dr. Cathey noted that the claimant was morbidly obese and moved with an exaggerated degree of caution and deliberation. Dr. Cathey believed that the claimant was a victim of degenerative lumbar disc disease with associated osteoarthritis. Dr. Cathey credibly opined that, rather than continued prescriptions of Soma and Darvocet, the claimant should take aspirin, Advil, or other nonsteroidal anti-inflammatory medications. [13] Further, we note that the claimant has failed to proffer an opinion from any physician which would indicate that the claimant’s degenerative disc disease, osteoarthritis, and hypertrophic facet joint changes are causally related to the 1987 injury or 1989 surgery. The claimant has also failed to proffer any opinion that she should continue to use prescription medication, other than over-the-counter type medicine recommended by Dr. Cathey. Therefore, we find that the claimant has failed to prove that continued prescription medication is reasonable and necessary to treat her 1987 work-related back injury. Accordingly, we affirm the decision of the administrative law judge and dismiss this claim. [14] IT IS SO ORDERED.Her MRI scan confirms the presence of an old laminectomy defect on the right at L5. There does not, however, appear to be any sign of recurrent disc herniation, significant spinal stenosis, etc. While there is some degenerative facet changes noted at L4/L5 on the left, I do not see any significant nerve root impingement.
I have indicated to Ms. Benton that I believe she is the victim of degenerative lumbar disc disease with associated osteoarthritis. Unfortunately, this is not the sort of thing that will respond favorably to any additional lumbar disc surgery.
ELDON F. COFFMAN, Chairman MIKE WILSON, Commissioner
[15] Commissioner Humphrey dissents.