CLAIM NO. D813830
Before the Arkansas Workers’ Compensation Commission
OPINION FILED MAY 12, 2000
Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas.
Claimant represented by the HONORABLE GARY DAVIS, Attorney at Law, Little Rock, Arkansas.
Respondents represented by the HONORABLE KEVIN STATEN, Attorney at Law, Little Rock, Arkansas.
Decision of Administrative Law Judge: Affirmed.
OPINION AND ORDER
The respondents appeal to the Full Workers’ Compensation Commission an administrative law judge’s opinion filed September 1, 1999. The administrative law judge found that the claimant is entitled to ongoing medical treatment for her back difficulties which arise from a compensable injury of February 1986, and that the claimant is entitled to medical treatment generated as a result of her complaints with her low back in September of 1998. After de novo review of the entire record, the Full Commission affirms the opinion of the administrative law judge.
I. HISTORY
The claimant, Mary Bacon, sustained a compensable low back injury in February, 1986, from which she sustained a recurrence in March, 1992. In an opinion filed September 20, 1995, the administrative law judge directed the respondents to pay all reasonable and necessary medical expenses which had been incurred or may be incurred as a result of the 1986 and 1992 compensable events. The claimant was treated beginning in July, 1998 by Dr. Laura Trigg, Dr. Steven Nokes, and Dr. Carl Covey for complaints of back pain radiating into her lower extremities. The following impression resulted from an MRI of the lumbar spine taken September 25, 1998:
1. Small recurrent left foraminal disc herniation at L4-L5 compromising the left L4 nerve root in the foramen. There is associated moderate left lateral recess scarring at this level.
2. Changes of left laminectomy at L5-S1.
3. Postoperative changes at the thoracolumbar junction.
Dr. Covey reported on October 2, 1998:
A pertinent history is that of 6 previous spine surgeries, 3 in the lumbar spine, none of which were fusions. A thoracic spine infusion and cervical surgeries apparently both fusions. She’s had episodic problems with back pain but this has been a significant recurrence and the left lower extremity pain is also new although she has had left lower extremity pain in the past prior to her lumbar spine surgeries.
She had seen Dr. Trigg in consultation on September 21st. Dr. Trigg had ordered an MRI which documents a new recurrent left sided herniation at L4-5 compromising the left L4 nerve root. There is significant lateral recess scarring, probably related to her previous surgeries, epidural fibrosis at this level as well.
Dr. Trigg wrote in June, 1999:
The MRI did indeed show a recurrent disc herniation in the area in which she had had a prior left sided laminectomy. I do feel that her current need for treatment is related to the back problems for which she has been receiving treatment in the past. I cannot, however, comment about the injury in 1986 as I was unaware of that history. However, she does have degenerative disc disease with a current disc herniation in the area of her prior surgery related to her prior diagnosis of degenerative disc disease.
The claimant contended that the September, 1998 MRI and subsequent treatment for her low back are causally related to her compensable injury of February, 1986. The respondents controverted the claim for additional medical treatment, contending that the September, 1998 MRI and subsequent treatment to the claimant’s low back are unrelated to the original compensable injury. After the parties submitted the case to the Commission on their briefs and attached medical exhibits, the administrative law judge determined, in an opinion filed September 1, 1999:
This examiner sees little difference in the medical opinions relative to causal relation between Dr. Covey and Dr. Trigg. Dr. Covey states in his report of October 2, 1998, that the claimant was having a significant recurrence of left lower extremity pain and states that it is new, although, he finishes his sentence by saying, “although she has had left lower extremity pain in the past prior to her lumbar spine surgeries.”
This examiner chooses to place the greater weight of the more definitive report generated by Dr. Trigg in June of 1999.
The administrative law judge therefore directed the respondents to pay ongoing medical benefits; the respondents appealed to the Full Commission.
The Full Workers’ Compensation Commission filed an order on January 26, 2000, holding that the parties and administrative law judge had failed to prepare an adequate record for our review. The Full Commission vacated the decision of the administrative law judge and remanded to settle the record. In an order filed February 14, 2000, the administrative law judge found that “a supplemental record has been prepared, including all transcripts, orders and opinions which have been rendered in this case. . . . After a review of previous transcripts and opinions which constitute the supplemental record in this case, the Findings of Fact and Conclusions of Law set forth by the Administrative Law Judge in the Opinion filed September 1, 1999, remain unchanged.”
II. ADJUDICATION
Employers must promptly provide medical services which are reasonably necessary for treatment of compensable injuries. Ark. Code Ann. § 11-9-508(a) (1987). Injured employees have the burden of proving, by a preponderance of the evidence, that medical treatment is reasonably necessary for treatment of the compensable injury. Norma Beatty v. Ben Pearson, Inc., Full Workers’ Compensation Commission, Feb. 17, 1989 (D612291). In assessing whether a given medical procedure is reasonably necessary for treatment of the compensable injury, we analyze both the proposed procedure and the condition it is sought to remedy. Deborah Jonesv. Seba, Inc., Full Workers’ Compensation Commission, Dec. 13, 1989 (D511255). What constitutes reasonable and necessary medical treatment is a fact question for the Commission. WrightContracting Co. v. Randall, 12 Ark. App. 358, 676 S.W.2d 750
(1984).
In the present matter, the claimant sustained a compensable back injury in 1986 and a compensable recurrence in 1992. In 1995, the administrative law judge directed the respondents to provide reasonable and necessary medical treatment which had incurred or may be incurred as a result of the claimant’s compensable injury. The claimant contends that she is entitled to continued medical treatment which is causally related to her compensable injury. The claimant cites treating physician Dr. Trigg’s 1999 report, to wit: “I do feel that her current need for treatment is related to the back problems for which she has been receiving treatment in the past.” The administrative law judge relied on this medical report in finding that the claimant is entitled to ongoing medical treatment for her back difficulties which arise from the 1986 compensable injury.
In reviewing the entire record de novo, we note that Dr. Trigg opined that the claimant’s current need for treatment at L4-5 is causally related to the back problems for which she has received treatment in the past. Further, the Commission has found that the claimant’s 1992 L4-5 back problems were a recurrence of her 1986 work-related injury at L4-5. Therefore, we find that the claimant has established, by a preponderance of the evidence, that her L4-5 disc herniation diagnosed in 1998 is causally related to the 1986 and 1992 work-related back problems for which the respondents have been liable for treatment.
Accordingly, based on our de novo review of the entire record, and for the reasons discussed herein, the Full Commission affirms the administrative law judge’s finding that the claimant is entitled to ongoing medical treatment for her back difficulties, which difficulties arise from the February, 1986 compensable injury. We affirm the administrative law judge’s finding that the claimant is entitled to medical treatment generated as a result of her complaints with her low back in September, 1998. The Full Commission thus affirms in its entirety the opinion of the administrative law judge.
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 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
________________________________
PAT WEST HUMPHREY, Commissioner
Commissioner Wilson dissents.
DISSENTING OPINION
I must respectfully dissent from the majority’s opinion finding that the claimant is entitled to ongoing medical treatment for her back difficulties. Based upon my de novo review of the record, I find that the claimant has failed to meet her burden of proof. Accordingly I would reverse the decision of the Administrative Law Judge.
The issue before the Commission at this time is whether or not the claimant’s recurrent disc at L4-5 is related to her February 13, 1986, on-the-job injury with the respondents. In my opinion, the claimant has failed to meet her burden of proof. A September 21, 1998, MRI indicated a recurrent disc at L4-5. This MRI is compared to a previous MRI performed in 1994. All doctors have agreed that there is a substantial difference between the 1994 MRI and the 1998 MRI. The claimant has undergone six spinal surgeries in her lifetime and not all of her problems can be related to the incident that occurred in 1986.
Dr. Steven Nokes, a radiologist, reviewed the claimant’s 1998 MRI and 1994 MRI. On September 25, 1998, he diagnosed a “recurrent” disc at L4-5 and stated that “this has occurred since the previous study.” On October 2, 1998, Dr. Carl Covey stated in a narrative report that there is a “new onset of low back pain and left lower extremity pain” and diagnosed this as a “significant recurrence” and new left lower extremity pain. His impression was a recurrent disc herniation at L4-5. Dr. Laura Trigg commented on September 21, 1998, that there was a “new recurrent left sided herniation at L4-5.” Dr. Trigg commented on June 4, 1999, that the claimant had a small recurrent disc at L4-5 and that this was a change from the prior MRI.
The medical evidence simply does not support a finding that the claimant’s current problems at L4-5 are related to her compensable on-the-job injury from 1986. The history shows that this woman has had six back surgeries. Simply put, I cannot find the claimant’s on-going medical difficulties arise from her February 1986 compensable injury. Accordingly, I dissent from the majority’s opinion.
__________________________ MIKE WILSON, Commissioner