COTTON v. BALL PRIER, 1997 AWCC 372

CLAIM NO. E512437

JOHN COTTON, EMPLOYEE, CLAIMANT v. BALL PRIER, EMPLOYER, RESPONDENT and AETNA LIFE CASUALTY, CARRIER, RESPONDENT

Before the Arkansas Workers’ Compensation Commission
OPINION FILED SEPTEMBER 23, 1997

Upon review before the FULL COMMISSION, Little Rock, Pulaski County, Arkansas.

Claimant represented by JAY TOLLEY, Attorney at Law, Springdale, Arkansas.

Respondent represented by BETTY DEMORY, Attorney at Law, Little Rock, Arkansas.

Decision of Administrative Law Judge: Affirmed

[1] OPINION AND ORDER
[2] Claimant appeals from a decision of the Administrative Law Judge filed February 27, 1997, finding that claimant has failed to prove by a preponderance of the evidence that his right shoulder difficulties are a compensable consequence of claimant’s right leg injury. Based upon our de novo review of the entire record, we find that claimant has failed to meet his burden of proof. Therefore, we affirm the decision of the Administrative Law Judge.

[3] The claimant sustained an admittedly compensable injury to his lower right leg on August 3, 1995, during the course and scope of his employment. Claimant’s right leg injury was accepted as compensable and all medical benefits, and disability benefits associated therewith have been paid. Claimant’s right leg injury resulted in complications in the form of osteomyelitis which is a form of inflammation of the bone. The record reflects that the standard and most acceptable way of treating osteomyelitis consists of inserting an IV into the patient’s right shoulder in order to administer medication. It is claimant’s contention that this form of treatment has resulted in complications in his right shoulder and thus the right shoulder difficulties are a compensable consequence of the compensable right leg injury. Respondent contends that claimant has failed to prove by a preponderance of the evidence a causal connection between claimant’s right leg injury and his right shoulder difficulties. After reviewing the evidence impartially, without giving the benefit of the doubt to either party, we agree with respondent. [4] When the primary injury is shown to have arose out of and in the course of the employment, the employer is responsible for every natural consequence that flows from that injury. McDonaldEquipment Co. v. Turner, 26 Ark. App. 264, 766 S.W.2d 936 (1989). However, the claimant must prove by a preponderance of the evidence that there is a causal connection between the primary injury and the subsequent disability. Giddry v. J. R. EadsConstruction Co., 11 Ark. App. 219, 669 S.W.2d 483 (1984). Consequently, the claimant must prove by a preponderance of the evidence that the disabling condition is a natural consequence flowing from the primary injury. In order to prove the compensability of an alleged compensable consequence, all requirements for proving compensability apply. Claimant must meet his burden to prove that the treatment and diagnosis of his shoulder problems is a compensable consequence by a preponderance of the evidence and he must meet his burden by presenting medical evidence supported by objective findings. Ark. Code Ann. §11-9-101 (16); Dodd v. Service American Corp., FC Opinion August 29, 1995, (E313993). Finally, except in the most obvious cases, the existence of a causal relationship must be established by expert medical evidence. See, Billy Wayne Jeter v. B R McGintyMechanical, FC Opinion March 6, 1997, (E208256); Ortho R. Wells v.Armstrong Rubber Co., FC Opinion April 14, 1997, (D100998); andCarolyn Jackson v. Bosley Construction, Inc., FC Opinion March 6, 1997, (E009401). [5] Although claimant’s treating physicians have not all agreed on the exact problem or etiology of claimant’s right shoulder difficulties, all physicians do agree that claimant’s right shoulder difficulties are not related to claimant’s compensable right leg injury. Dr. Rolniak and Dr. Swendell have diagnosed claimant’s right shoulder difficulty as reflex sympathetic dystrophy. However, Dr. Minh Tam Dang has stated that the various tests conducted on claimant do not confirm a diagnosis of reflex sympathetic dystrophy. [6] The record reveals that claimant underwent the IV procedure to treat the osteomyelitis shortly after the initial injury in August of 1995. Claimant did not complain of right shoulder difficulties until presenting to the emergency room on May 7, 1996. At that time, claimant provided a history of shoulder pain beginning on May 6, 1996, with no known trauma. While in the hospital, claimant underwent extensive testing all of which were interpreted as essentially normal. [7] The record reveals that claimant has received treatment for his shoulder difficulties from several physicians. In a report dated June 18, 1996, Dr. W.G. Swendell stated that there was no causal connection between the IV and claimant’s current right shoulder problems. Specifically, Dr. Swendell stated:

I am writing in reference to your letter dated June 13, 1996, regarding Mr. John Cotton. As you know, Mr. Cotton was admitted to the hospital May 8, 1996, for evaluation of severe right shoulder and arm pain, and discharged on May 11, 1996. This was in the same side that he had had a subclavian placed several months ago for osteomyelitis of the leg. Evaluation in the hospital revealed no apparent association between the pain in his shoulder and the subclavian.

[8] Claimant began treatment with Dr. W.A. Rolniak for the diagnosis of reflex sympathetic dystrophy of his right arm. In a report dated July 9, 1996, Dr. Rolniak did state that claimant’s reflex sympathetic dystrophy of the right arm was due to claimant’s on-the-job injury in August of 1995. However, in a subsequent report dated November 7, 1996, Dr. Rolniak explained that at the time of authoring the July 9, 1996, report he was under the mistaken belief that claimant actually sustained an injury to his right shoulder in August of 1995 as opposed to an injury to the leg. In the November 7, 1996, report Dr. Rolniak stated:

Mr. Cotton told me that his on-the-job injury (on August 3, 1995) involved his right shoulder and that it was sustained with some unaccustomed activity-hammering on tires. I was not aware that the job injury sustained in August had any relation to his right shin and I do not know of any possible connection between an injury to his shin and the right shoulder pain are signs and symptoms of reflex sympathetic dystrophy that he is demonstrating now. I would have to say that I think possibly Mr. Cotton mislead me initially with regard to the site of his on-the-job injury.

[9] Finally, Dr. Minh Tam Dang, another of claimant’s treating physicians noted in a July 19, 1996, report that claimant does not have any nerve problems of his right arm “. . . and it is unbelievable that the IV treatment more than a year ago induced these problems.” [10] The only possible causal connection between claimant’s right shoulder difficulties and his compensable injury is the mere coincidence that an IV was placed in claimant’s right shoulder to treat claimant’s right leg complications. However, when the medical evidence is reviewed it is clear that claimant’s treating physicians have unequivocally and uniformally agreed that there is no relationship between the IV placed in claimant’s right shoulder and claimant’s subsequent right shoulder difficulties. Accordingly, we find that claimant has failed to prove any causal relationship between his right shoulder difficulties and his compensable right leg injury. Therefore, we find that the decision of the Administrative Law Judge should be and hereby is affirmed. [11] IT IS SO ORDERED.

ELDON F. COFFMAN, Chairman MIKE WILSON, Commissioner

[12] Commissioner Humphrey dissents.