CLAIM NO. D706097 D907354
Before the Arkansas Workers’ Compensation Commission
OPINION FILED JUNE 6, 2001
Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas.
Claimant appeared pro se.
Respondents represented by HONORABLE BETTY DEMORY, Attorney at Law, Little Rock, Arkansas.
Decision of Administrative Law Judge: Reversed.
OPINION AND ORDER
The claimant appeals that portion of the administrative law judge’s opinion and order finding that the claimant failed to prove by a preponderance of the evidence that any medical treatment is reasonably necessary for treatment of his compensable injury. After conducting a de novo review of the entire record, we find that the administrative law judge’s decision in this regard must be reversed.
The record includes an opinion filed by an administrative law judge on December 27, 1989, which held that claimant proved entitlement to wage-loss benefits totaling 10% to the whole body. The decision showed that claimant sustained an admittedly compensable back injury in 1987. Diagnostic testing revealed a disc herniation at L5- S1. Surgery was recommended by Dr. Fletcher; however, claimant declined. Ultimately, he received a referral to Dr. Ron Williams. In 1988, Dr. Williams stated that although claimant had a disc herniation with right S1 radiculopathy, indications for surgical intervention were bowel or bladder paralysis or broad motor weakness. Since claimant did not exhibit these symptoms, Dr. Williams opined that he was not a surgical candidate. He assigned an impairment rating of 7%. Based on degenerative changes evident on an MRI at L4-5 and L5-S1, Dr. Williams increased claimant’s impairment rating by 5%. Again, he concluded that claimant was not a candidate for surgery. After reviewing a functional capacity evaluation, Dr. Williams stated that it was doubtful that claimant could return to work. The Commission affirmed and adopted the administrative law judge’s decision.
Following the litigation of claimant’s claim, he continued to receive medical care for his compensable injury. Respondents accepted liability for this treatment. In 1992, after concluding once more that claimant was not a surgical candidate, Dr. Williams referred claimant to Dr. Christopher D. Adams to determine if “he can be helped medically.” Respondents accepted responsibility for this treatment as well.
On October 18, 1999, claimant had a laminectomy at L3-4, on the left. Claimant does not contend that this abnormality is causally connected to his compensable injury. In correspondence to the Commission requesting a hearing, claimant stated he received information that his workers’ compensation case was “closed” effective May 22, 2000. His letter indicated that according to Ms. Shamlin, a representative of Ace USA, the decision was predicated upon the opinion of Dr. Ron Williams. The record also includes correspondence from Dr. Williams to Ms. Shamlin dated December 17, 1999. In his letter, Dr. Williams stated, in part:
. . .Mr. Judkins’ main problem following his original injury in 1997 [sic] has been referrable to the L5-S1 disc and to a lesser degree the L4-5 disc. I think it is certainly a possibility that the injury to his back resulted in the herniation at the L3-4 disc, but it probably is a chronic problem that has happened since his injuries.
It is claimant’s contention that he is entitled additional treatment for his work-related injury, including the medication prescribed by Dr. Adams explicitly for that purpose. He asserted that the lumbar laminectomy performed at L3-4 on the left does not affect his entitlement to medical treatment for his original injury at L4-5 and L5-S1 on the right.
Respondents advanced the argument that additional medical treatment is not causally related to his original compensable injury. Moreover, they contend that further medical treatment is not reasonably necessary.
To support his claim for additional medical treatment, claimant furnished correspondence authored by Dr. Christopher D. Adams. Dr. Adams indicated that he is treating claimant for lumbar spondylosis with radiculopathy. In a letter dated May 26, 2000, Dr. Adams enumerated the medications he prescribed:
Ultram is an analgesic used to treat chronic pain. Serzone is officially listed by the FDA as an antidepressant, but is regularly used in pain management programs because of its beneficial modulation on chronic pain (not just depression). Celebrex is an anti-inflammatory and anti-osteoarthritis drug with recognized analgesic benefit. Zostrix (topical capsaicin) is recommended by the American College of Rheumotology as second line treatment of degenerative disease in certain conditions such as osteoarthritis of the knee. It is also beneficial for treating osteoarthritis at other cites. Hydrocodone is a more potent analgesic than Ultram, and is used when Ultram alone is insufficient. Cyclobenzaprine is a muscle relaxer used to treat the spasm which occurs with [claimant’s] injury. Trazadone also is used to treat chronic pain and muscle problems. Although officially it is listed as an antidepressant, this medicine helps restore rest and diminish muscle spasticity.
Dr. Adams drafted a subsequent letter dated June 27, 2000, which provided:
Please forgive my frustration; I have really made an extraordinary effort over the years (above and beyond the usual “increasing and incessant demands” of medical documentation) to be sure that we carefully note which medications Mr. Judkins takes for Workman’s Compensation injuries and which are not.
Permit me to explicitly and specifically state that Mr. Bobby Judkins takes Ultram, Serzone, Celebrex, Zostrix, Vicodin, Flexeril, Desyrel, and Arthflex Max for lumbar spondylosis with radiculopathy as a result of [an] injury which was determined to be compensable by decision of Workman’s Compensation several years ago. While these medicines may be of benefit to him for other medical problems, they are specifically and explicitly prescribed for the purpose of treating his Workman’s Compensation-related problems.
Please refer to my May 26th correspondence regarding the particular reasons for prescribing each of these medicines. Hopefully, you and the court realize that treatment of chronic pain includes the use of medicines which have a primary FDA indication for other purposes (such as antidepressants).
Hopefully, this letter will serve as continuing evidence that I am conforming with the request of the administrative law judge who requested that I specifically document which medicines were related to his Workman’s Compensation injury in each of my clinic notes. My opinion regarding Mr. Judkins’ need for these medications has not changed in the last several years, and his use of these medicines has been both medically indicated and appropriate. Please let me know if this is not clear.
The evidence showed that prior to May of 1999, the sole exception to respondents’ payment of claimant’s medical expenses involved pharmacy mileage. On March 31, 1999, Ms. Cindy Farzley notified claimant that medical mileage for pharmacy trips would be disallowed in the future. Ms. Farzley explained that respondents attempted to furnish medication through a mail order pharmacy but claimant refused to accept the service.
In short, the respondents continued to pay for treatment rendered by Dr. Adams for seven years, as well as the medication he prescribed, which was reasonably necessary and related to claimant’s compensable injury. The decision to deny benefits was apparently made in light of claimant’s surgery for an unrelated defect at L3-4. It appears that respondents treated the existence of another lumbar defect as an automatic bar to additional medical treatment. This is not the law.
We find that claimant has met his burden of proof that additional treatment for his compensable back injury remains even after his unrelated L3-4 back surgery. In this regard, Dr. Williams referred claimant to Dr. Adams because surgical intervention was inappropriate. Dr. Adams indicated that claimant’s treatment is for lumbar spondylosis with radiculopathy. He experiences chronic pain, which is managed with medication. In June of 1999, Dr. Adams stated that his opinion had not changed regarding the treatment of claimant’s condition. In an effort to accommodate the insurance carrier, Dr. Adams specified the condition for which each medication was prescribed. He noted that although the medications may help other conditions, they were prescribed specifically for his work-related injury.
The administrative law judge has suggested that Dr. Adams’ narrative reports are not sufficient for the claimant to meet his burden of proof, and that the claimant should also have submitted into the record Dr. Adams’ clinical notes and/or other reports from Dr. Adams documenting the nature of the problems for which the claimant sought treatment. The administrative law judge also noted that the claimant did not testify regarding the nature of his problems since the prior hearing. On this point, however, we note that Dr. Adams’ narratives in the record appears to be self-explanatory, and absent any allegations by the respondents that Dr. Adams’ narratives are based on inaccurate information, we fail to see the value of the additional evidence suggested by the administrative law judge. Furthermore, it would appear that, if some issue arose as to the validity of the information contained in Dr. Adams’ narratives, it would be the respondents, not the claimant, seeking to introduce any additional medical reports that might rebut Dr. Adams’ explanations for his prescriptions and treatment at issue. On this record, Dr. Adams’ unrebutted medical narratives constitute a preponderance of the evidence on the treatment issue presented. Therefore, after conducting a de novo
review of the entire record, and for the reasons discussed herein, we find that the administrative law judge’s denial of additional medical benefits must be and hereby is, reversed.
IT IS SO ORDERED.
________________________________ ELDON F. COFFMAN, Chairman
________________________________ SHELBY W. TURNER, Commissioner