CLAIM NO. E121284
CARL STEVEN BULLOCK, EMPLOYEE, CLAIMANT v. COSTELLO INDUSTRIES, EMPLOYER, RESPONDENT, ST. PAUL INSURANCE CO., INSURANCE CARRIER, RESPONDENT
Before the Arkansas Workers’ Compensation Commission
OPINION FILED JANUARY 8, 1996
Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas.
Claimant represented by the HONORABLE WALTER A. MURRAY, Attorney at Law, Little Rock, Arkansas.
Respondents represented by the HONORABLE MICHAEL VANDERFORD, Attorney at Law, Little Rock, Arkansas.
Decision of Administrative Law Judge: Reversed.
[1] OPINION AND ORDER
[2] The respondents appeal an opinion and order filed by the administrative law judge on March 16, 1995. In that opinion and order, the administrative law judge found that certain medical treatment was reasonably necessary for treatment of the claimant’s injury. After conducting a de novo review of the entire record, we find that the Administrative Law Judge’s decision must be reversed.
[3] The respondent employer is in the business of resurfacing roads, and the claimant was employed by the respondent employer as a micro-surfacing superintendent. On November 26, 1991, the claimant sustained an admittedly compensable injury to his right knee when the wind from a passing truck caused him to fall into a gully. The claimant came under the care of Dr. Michael J. Weber, an orthopedic surgeon, and Dr. Weber initially treated the claimant conservatively. However, due to the claimant’s continued complaints, Dr. Weber performed arthroscopic surgery with debridement on December 10, 1991. While Dr. Weber’s reports indicate that this surgery improved the claimant’s complaints to some extent, his reports also indicate that the claimant continued to complain of problems, including pain and popping of the knee. Although Dr. Weber released the claimant to return to work on March 19, 1992, his March 9, 1992, report states that the claimant was still complaining of “some painful snapping of his knee cap,” and his March 23, 1992, report states that the claimant was still complaining of tenderness between his knee cap and the tibial tubercle.” Dr. Weber opined that these problems should resolve with time.
[4] The claimant’s employment with the respondent employer was terminated before he could return to work, so he started his own landscaping business. However, he continued experiencing problems with the knee. Due to these problems, he came under the care of Dr. James S. Mulhollan, an orthopedic specialist who specializes in knees. Dr. Mulhollan first examined the claimant on July 7, 1992, and his report indicates that the claimant was complaining that he was “still having problems” and that his knee had a tendency to “give away” and “to pop.” Dr. Mulhollan initially opined that the claimant’s activity level and exercise program was inappropriate and needed to be changed.
[5] In August of 1992, the claimant underwent quadruple coronary bypass surgery. On approximately September 3, 1992, the claimant fell when his right leg allegedly gave way as he was attempting to get out of bed, and he experienced an increase in the popping and pain in his knee. Due to these problems, he saw Dr. Mulhollan on September 8, 1992. The claimant again returned to Dr. Mulhollan on November 23, 1993, with “marked complaints of pain in his knee after sitting for any period” and of “burning below the knee and of increased discomfort instead of improvement as time has passed.” Dr. Mulhollan concluded that the claimant’s “knee is interfering with [his] ability to exercise, and I think that is counterproductive.” Consequently, Dr. Mulhollan concluded that “it will be reasonable to arthroscope the patient for the purpose of finding out if there is any additional pathology in this knee.”
[6] Employers must promptly provide medical services which are reasonably necessary for treatment of compensable injuries. Ark. Code Ann. §
11-9-508 (a) (1987). However, 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 (Claim No.
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 Jones v. Seba,. Inc., Full Workers’ Compensation Commission, Dec. 13, 1989 (Claim No.
D511255). Employers may be liable for the treatment of preexisting conditions to the extent that treatment may be necessary to accomplish treatment of the injury. Artex Hydrophonics. Inc. v.Pippin,
8 Ark. App. 200,
649 S.W.2d 845 (1983). However, employers are not required to pay medical expenses for the evaluation and treatment of conditions unrelated to the compensable injury, except to the extent necessary to accomplish treatment of the injury. Id. Likewise, employers are not required to pay to rule out with absolute certainty the possibility of non-compensable causes of the complaints. Jeffrey Motes v.Campbell Soup Co., Full Workers’ Compensation Commission, May 15, 1985 (Claim No.
D401646); Claude Vaulner v. BurlingtonIndustries, Full Workers’ Compensation Commission, opinion filed May 10, 1993 (Claim No.
E108422).
[7] In the present claim, we find that the claimant failed to prove by a preponderance of the evidence that the procedure recommended by Dr. Mulhollan is reasonably necessary for treatment of the claimant’s compensable injury. In this regard, Dr. Mulhollan’s deposition testimony indicates that his recommendation is based on the claimant’s continued complaints and on the failure of other diagnostic procedures to reveal any explanation for the claimant’s continued complaints. In light of these considerations, Dr. Mulhollan concluded that it was reasonable to “look in the knee to see if there was an anatomic explanation for his poor status.” However, the arthroscopic procedure performed by Dr. Weber soon after the compensable accident did not reveal any correctable abnormality which would explain the claimant’s continued complaints, and, as indicated, other diagnostic procedures have revealed only minimal findings. Moreover, while Dr. Mulhollan has opined that “the possibility of helping him is significant,” he has also opined that the “possibility of not changing his status is fairly high.”
[8] In short, the procedure recommended by Dr. Mulhollan is exploratory in nature, and he concedes that the probability of this procedure not helping the claimant is fairly high. Therefore, we find that the claimant failed to prove by a preponderance of the evidence shows that the procedure recommended by Dr. Mulhollan is reasonably necessary for treatment of the compensable injury.
[9] We also find that the claimant failed to prove by a preponderance of the evidence that a chest x-ray ordered by Dr. Mulhollan after the claimant’s fall in September of 1993 is reasonably necessary for treatment of the compensable injury. In this regard, the claimant testified that he was getting out of bed when his right leg gave away, and he testified that his right rib cage struck an object sitting next to the bed as he fell. Subsequently, he experienced chest pain. However, he was recuperating from quadruple by-pass surgery at the time of this incident, and he conceded that he was extremely weak as a result of this surgery. Moreover, a vein was taken from his left knee to perform the surgery, and the claimant admitted that he was experiencing serious problems with his left leg as a result of the surgical removal of the vein. Moreover, other than the fact that the claimant had previously experienced give-away weakness in his right knee, there is no other evidence tending to link this fall to the compensable injury. Consequently, we find that the claimant failed to show by a preponderance of the evidence that the fall was a compensable consequence of the compensable injury. Therefore, we find that the claimant failed to prove by a preponderance of the evidence that the chest x-ray ordered by Dr. Mulhollan was reasonably necessary to evaluate whether the claimant had sustained additional injuries as a result of the fall.
[10] In addition, we find that the claimant failed to prove by a preponderance of the evidence that his colitis is causally related to his compensable injury. In this regard, the claimant began to experience abdominal pain and rectal bleeding in November of 1992, and an endoscopy was performed by Dr. Brett C. Davis which revealed minimal colitis. Dr. Davis has noted that some of the medications which the claimant was taking for his compensable injury can cause diarrhea. However, Dr. Davis has also opined that “[i]t is unlikely that this man’s rectal bleeding was related to Feldene and that the rectal bleeding is most likely related to internal hemorrhoids or possibly inflammatory bowel disease.” Therefore, we find that the claimant failed to prove by a preponderance of the evidence that his gastric problems were causally related to his compensable injury.
[11] Accordingly, based on our de novo review of the entire record, and for the reasons discussed herein, we find that the claimant failed to prove by a preponderance of the evidence that the procedure recommended by Dr. Mulhollan is reasonably necessary for treatment of the compensable injury. In addition, we find that the claimant failed to prove by a preponderance of the evidence that the x-ray ordered by Dr. Mulhollan or the evaluation or treatment of his gastric complaints were causally related to the compensable injury. Therefore we find that the respondents are not liable for these procedures. Thus, we find that the Administrative Law Judge’s decision must be, and hereby is, reversed. This claim is hereby denied and dismissed.
[12] IT IS SO ORDERED.
JAMES W. DANIEL, Chairman ALICE L. HOLCOMB, Commissioner
[13] Commissioner Humphrey dissents.
