CLAIM NO. E810367
TERESA CRANFORD, EMPLOYEE, CLAIMANT v. WAL-MART STORES, EMPLOYER, RESPONDENT and CMI, TPA, CARRIER, RESPONDENT Before the Arkansas Workers’ Compensation Commission
OPINION FILED JULY 15, 1999
Upon review before the FULL COMMISSION, Little Rock, Pulaski County, Arkansas.
Claimant represented by ROBERT L. DEPPER, JR., Attorney at Law, El Dorado, Arkansas.
Respondent represented by MIKE ROBERTS, Attorney at Law, Little Rock, Arkansas.
Decision of Administrative Law Judge: Affirmed in part and reversed in part.
[1]
OPINION AND ORDER [2] The respondent appeals a decision of the Administrative Law Judge filed on February 19, 1999. Based upon our de novo review of the entire record, we affirm the decision of the Administrative Law Judge in part and reverse in part. Specifically, we affirm the decision of the Administrative Law Judge finding that claimant has proven entitlement to temporary total disability benefits from August 26, 1997 through September 9, 1997. However, we reverse the decision of the Administrative Law Judge finding that claimant presently remains in her healing period and continues to require medical treatment relative to her August 16, 1997 compensable injury. [3] At the hearing held on November 18, 1998, claimant contended that she sustained a compensable injury on August 16, 1997, for which she is entitled to temporary total disability benefits. Claimant further contended that until she receives further medical treatment, she remains in her healing period. Conversely, respondent contended that claimant was never totally incapacitated from earning wages as a light-duty position was made available for claimant. Respondent further contended that claimant’s injury resolved as there were no objective medical findings supporting a continuing injury and, thus, additional medical treatment after August 26, 1997, (or, in the alternative, September 25, 1997) is not reasonable and necessary medical treatment related to claimant’s compensable injury. [4] In his Opinion delivered February 19, 1999, the Administrative Law Judge found that claimant has proven entitlement to temporary total disability benefits from August 25, 1997 through September 9, 1997; that claimant remains in her healing period; and that she continues to require medical treatment relative to her compensable injury. Respondent filed a timely Notice of Appeal from the Opinion of the Administrative Law Judge. Respondent has not appealed from the decision of the Administrative Law Judge awarding claimant temporary total disability benefits from August 25, 1997 through September 9, 1997. Accordingly, we find that this finding of the Administrative Law Judge should be affirmed. However, we find that claimant has failed to prove by a preponderance of the evidence that she remains within her healing period, or that she continues to require medical treatment for her compensable injury. Therefore, we find that these findings of the Administrative Law Judge should be reversed. [5] It is undisputed that claimant sustained a compensable injury to her right wrist on August 16, 1997. As a result of her injury, claimant sought medical care from Dr. Judson Hout. Dr. Hout’s August 19, 1997 office report reveals the following findings:
She is still having pain in her wrist and had to leave the job today although they had given her light duty. She says the Darvocet has not completely helped. There is still some tenderness, but I believe it is much less than it was yesterday. There is no particular swelling today.
[6] Dr. Hout diagnosed claimant with a severe sprain of the right wrist and forearm. [7] The medical records reveal that claimant continued to seek follow-up treatment from Dr. Hout and was eventually referred to Dr. Jay M. Lipke, an orthopedic surgeon. Claimant was examined by Dr. Lipke on August 26, 1997. Dr. Lipke’s physical examination revealed:
Examination reveals some swelling about the wrist and she tends to hold the wrist and fingers in a flexed position. Any movement of the wrist and hand tends to accentuate her pain. She has mild swelling.
Plan x-rays show no abnormalities other than a congenital coalition of the lunotriquetral bones.
[8] Dr. Lipke diagnosed claimant with a ligamentous sprain of the wrist with secondary acute carpal tunnel syndrome. Dr. Lipke injected claimant’s carpal tunnel with Celestone and Marcaine while prescribing steroids and Decadron. [9] Although claimant was seen by Dr. Lipke on August 26, she presented to the emergency room with Ouachita County Medical Center on August 27, 1997, complaining of pain in her wrist. At that time, the medical care providers noted that there was no swelling in claimant’s wrist, but that claimant’s wrists were tender to the touch. [10] Claimant was next seen by Dr. Hout on August 28, 1997, for an elective visit. This office visit, however, concerned claimant’s request for diet pills and fails to mention any complaints regarding claimant’s right wrist. Nonetheless, an examination was performed and Dr. Hout specifically recorded: “Extremities no edema.” Claimant returned to Dr. Lipke’s office on September 9, 1997, again with significant complaints of pain in her wrists, hand and fingers. A review of Dr. Lipke’s September 9, 1997 office report fails to disclose the presence of any objective medical findings although she continued to have subjective complaints of pain. At that time Dr. Lipke ordered nerve conduction studies. These studies were performed on October 1, 1997 and revealed normal findings throughout claimant’s right upper extremity. [11] Pursuant to the medical records introduced into evidence, claimant was not examined again by a physician until June 16, 1998. At that time, claimant’s complaints involved diarrhea and upper abdominal pain, with no mention of any complaints related to claimant’s compensable right-wrist injury. [12] Claimant has the burden of proving by a preponderance of the credible evidence that medical treatment is reasonable and necessary. Norma Beatty v. Ben Pearson, Inc., Full Commission Opinion, Feb. 17, 1989 (
D612291); B.R. Hollingshead v. ColsonCaster, Full Commission Opinion, Aug. 27, 1993 (
D703346). Employers are only liable for medical treatment and services which are deemed reasonably necessary for the treatment of employees’ injuries. DeBoard v. Colson Co.,
20 Ark. App. 166,
725 S.W.2d 857 (1987). In workers’ compensation cases, the burden rests upon the claimant to establish her claim for compensation by a preponderance of the evidence. Kuhn v. Majestic Hotel,
50 Ark. App. 23,
899 S.W.2d 845 (1995); Bartlett v. Mead Container Board,
47 Ark. App. 181,
888 S.W.2d 314 (1994). When assessing whether medical treatment is reasonably necessary for the treatment of a compensable injury, we must analyze both the proposed procedure and the condition it is sought to remedy. Deborah Jones v. Seba,Inc., Full Commission Opinion, Dec. 13, 1989 (
D512553). Objective medical findings are only statutorily required to prove the compensability of an injury. Stephens Trucklines v. Millican,
58 Ark. App. 275,
950 S.W.2d 472(1997). [13] Objective medical findings are not the test to determine if medical treatment is reasonable and necessary medical treatment, however, they are one component which we may consider to determine whether a claimant has proven by a preponderance of the evidence that requested medical treatment is reasonable and necessary medical treatment related to the compensable injury. In the present claim, not only does claimant fail to exhibit objective medical findings on August 29, 1997, and on September 9, 1997, when she was examined by her treating physicians, but the EMG/NCV studies performed on October 1, 1997, also failed to disclose any objective medical findings. Claimant claims that she was unable to acquire medical treatment for her alleged continued complaints of pain since respondent controverted further treatment. However, there is no evidence in the record that claimant ever sought or required additional medical treatment other than that which has previously been provided by respondent. Moreover, the medical records reveal that on at least two occasions, claimant presented to her family physician seeking diet pills. Obviously, if claimant can pay for a doctor’s visit to obtain purely elective medical care for weight reduction, we see no reason why this claimant could not also return to her family physician for complaints related to her compensable injury should the need arise. Clearly, claimant did not return to her family physician with any complaints related to her right-upper extremity after she was last seen by Dr. Lipke on September 9, 1997. Accordingly, we are unable to find based upon this record before us that additional medical treatment is reasonable and necessary medical treatment for claimant’s compensable injury. By all accounts, claimant’s injury was resolving when she last saw Dr. Lipke on September 9, 1997, and there were no internal nerve injuries noted through diagnostic testing on October 1, 1997. Even before obtaining the EMG/NCV testing, the medical records reflect that claimant was no longer complaining of problems with her right-upper extremity when she sought medical treatment for weight reduction, and that the swelling had subsided. In reaching this finding, we are aware that both claimant and her husband testified that claimant still experiences difficulty with her arm and that her wrist continues to swell. However, we place greater weight on the unbiased medical records which fail to contain findings of a continuing injury or a need for treatment. Consequently, we find that the evidence fails to support a finding that claimant continues to require medical treatment for her compensable injury. Therefore, we find that this aspect of the Administrative Law Judge’s decision should be reversed. [14] With regard to the Administrative Law Judge’s finding that claimant remains in her healing period, we, likewise, find that this finding must be reversed. The healing period is defined as that period for healing of the injury that continues until the employee is as far restored as the permanent character of the injury will permit. Arkansas Highway Transp. Dept. v.McWilliams,
41 Ark. App. 1,
846 S.W.2d 670 (1993). If the underlying condition causing the disability has become more stable and if nothing further in the way of treatment will improve that condition, the healing period has ended. Id.; Mad Butcher, Inc.v. Parker,
4 Ark. App. 124,
628 S.W.2d 582 (1982). Conversely, the healing period has not ended so long as treatment is administered for the healing and alleviation of the condition.Arkansas Highway Transp. Dept. v. McWilliams, supra; J.A. RiggsTractor v. Etzkorn,
30 Ark. App. 200,
785 S.W.2d 51 (1990). The determination of when the healing period ends is a factual determination to be made by the Commission. Arkansas HighwayTransp. Dept. v. McWilliams, supra; Mad Butcher, Inc. v. Parker,supra. [15] The record is void of any evidence supporting claimant’s contention that she remains within her healing period for her compensable injury. When claimant was last seen by Dr. Lipke on September 9, 1997, she continued to complain of pain but all objective medical findings had resolved. Furthermore, the EMG/NCV tests confirmed the lack of any objective findings supportive of an injury. This lack of objective findings, when coupled with claimant’s failure to seek further medical treatment after last being seen by Dr. Lipke on September 9, 1997, demonstrate that claimant’s compensable injury had stabilized and that her injury was as far restored as the permanent character of the injury would permit. Therefore, we find that claimant’s healing period has ended. Accordingly, we find that the decision of the Administrative Law Judge finding that claimant remains in her healing period must, likewise, be reversed. [16] IT IS SO ORDERED.
ELDON F. COFFMAN, Chairman MIKE WILSON, Commissioner
[17] Commissioner Humphrey concurs in part and dissents in part. [18]
CONCURRING AND DISSENTING OPINION [19] I concur in the finding that claimant is entitled to temporary total disability benefits commencing on August 26, 1997 and ending on September 9, 1997. However, I must respectfully dissent from the findings that claimant failed to prove that she remains within her healing period and is entitled to additional medical treatment. [20] Dr. Jay Lipke authored a note excusing claimant from work that comports with the Administrative Law Judge’s temporary total disability award. However, respondents did not appeal the award of temporary total disability benefits. Therefore, this portion of the Administrative Law Judge’s opinion is affirmed. [21] The majority finds that claimant’s healing period ended on August 16, 1997, and that she is entitled to no further medical benefits. [22] With respect to claimant’s claim for additional medical care, the majority stated that “[b]y all accounts, claimant’s injury was resolving when she last saw Dr. Lipke on September 9, 1997, and there were no internal nerve injuries noted through diagnostic testing on October 1, 1997.” In reaching this determination, the majority discounts claimant’s testimony. However, I find that claimant offered credible testimony with respect to her continued symptoms. Specifically, she stated that she experiences swelling, particularly at night. Also, she has weakness in her right hand, and this causes her to drop objects. Claimant treats the swelling twice daily by soaking her wrist in Epsom salts and warm water. Davie Cranford, claimant’s spouse, corroborated claimant’s testimony with respect to the continuation of her symptoms. [23] Claimant acknowledged that she has not received medical treatment since her last appointment with Dr. Lipke. She explained that she is unable to afford medical treatment. Claimant remains symptomatic. She stated that she had no problems with her upper right extremity before the work-related incident. [24] In my opinion, claimant has demonstrated entitlement to additional medical treatment. Moreover, she has shown that she remains within her healing period. [25] Based on the foregoing, I respectfully dissent. [26] _________________________________ PAT WEST HUMPHREY, Commissioner