CUMBIE v. BOST HUMAN DEVELOPMENT SERVICES, 2000 AWCC 272

CLAIM NO. E913515.

VIVIAN R. CUMBIE, EMPLOYEE, CLAIMANT v. BOST HUMAN DEVELOPMENT SERVICES, EMPLOYER, RESPONDENT, AIG CLAIM SERVICES, INSURANCE CARRIER, RESPONDENT.

Before the Arkansas Workers’ Compensation Commission
ORDER FILED OCTOBER 13, 2000.

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

Claimant represented by the HONORABLE MICHAEL HAMBY, Attorney at Law, Greenwood, Arkansas.

Respondent represented by the HONORABLE R. SCOTT MORGAN, Attorney at Law, Pine Bluff, Arkansas.

Decision of the Administrative Law Judge: Affirmed.

OPINION AND ORDER

Respondent has appealed the decision of the administrative law judge that the claimant proved by a preponderance of the evidence that she is entitled to continuing medical treatment including prescriptions from October 1, 1999 forward and that she is entitled to a change of physician from her previous treating physician. After a de novo review of the entire record, we find that the administrative law judge’s decision should be affirmed.

At the hearing the claimant described the accident, and explained that Dr. Holder released her from his care but still provided prescriptions. The claimant wanted to see Dr. Standefer because she felt he could find what was working for her and fix what Dr. Holder could not, even though he had done a good job. The claimant testified that she has an action against the driver of the car that hit her. The claimant stated that her hip started hurting her a couple hours after the accident and that she did not go to the doctor for a few days when she had pain and a bruise. The claimant was never taken off work. The claimant had quit work because of her pain.

On June 15, 1998, the claimant was seen at the Cooper Clinic ProMed for a bruise on her hip from an auto accident on the previous Thursday.

On July 8, 1998, Dr. Harmon wrote that the claimant was “driving a van filled with kids and she had an accident. A person pulled out and hit her on the side. She thinks she slid over and hurt her buttocks area on the arm rest or something along that line. She was taking Daypro and it did seem to help. It was warm and bruised. . . It still continues to bother her some.” Dr. Harmon assessed contusion of the buttocks.

A July 30, 1998 radiographic exam of the claimant’s chest was unchanged from exams in 1995 and 1996.

On August 6, 1998 Dr. Harmon wrote that the claimant’s hip still bothered her after the June 11, 1998 accident. Dr. Harmon planned to refer her to Dr. Holder.

On August 6, 1998, the claimant underwent a radiographic study which showed degenerative changes to the spine, and calcifications over the soft tissues of the left buttock. The upper calcification was either old post-traumatic change or myositis ossificans and the calcification next to the greater trochanter was presumably the injection site but could represent calcification within the tendon.

On August 8, 1998, Dr. Harmon diagnosed a contusion of the hip and referred the claimant to Dr. Holder.

On August 14, 1998, Dr. Holder saw the claimant on referral from Dr. Harmon. The claimant reported pain in the left SI area with a burning type pain into the left buttock. Dr. Holder’s impression was left SI joint dysfunction and piriformis. The claimant had a Traumeel injection. Dr. Holder released the claimant to return to work.

On August 21, 1998 Dr. Holder wrote that the claimant’s discomfort was improving and that she had left SI joint dysfunction.

On August 24, 1998, Dr. Holder noted that the claimant still had pain across her lower back. He injected her with Traumeel. Dr. Holder’s impression was left SI joint dysfunction, and piriformis syndrome.

On August 26, 1998, Dr. Holder saw the claimant to perform a Traumeel injection. “She is doing significantly better today.” Dr. Holder diagnosed left SI joint dysfunction and lumbar strain.

On September 2, 1998, Dr. Holder injected the claimant’s left gluteus with Traumeel. His diagnosis was left SI joint dysfunction and lumbar strain.

On September 10, 1998, Dr. Holder noted that the claimant was getting good relief of her symptoms with physical therapy. His diagnosis was left SI joint dysfunction and piriformis syndrome.

On September 28, 1998, Dr. Holder wrote that the claimant was doing a little better. He diagnosed left SI joint dysfunction and piriformis syndrome. He returned her to work with no restrictions.

On October 29, 1998, Dr. Holder wrote that the claimant was doing better but had problems occasionally. He diagnosed left SI joint dysfunction, left piriformis syndrome, and left greater trochanteritis. Dr. Holder released the claimant to work with no restriction.

On December 2, 1998, Dr. Holder wrote that the claimant was doing well until a flare up the previous week. He diagnosed left SI joint dysfunction, left piriformis syndrome and left greater trochanteritis. Dr. Holder returned the claimant to work without restriction but with caution.

On December 29, 1998, Dr. Holder wrote that the claimant quit her job, that her medication was helping the left sacroiliac joint discomfort and that she had pain deep in her left hip and thigh. He diagnosed left sacroiliac joint dysfunction and left piriformis syndrome. The claimant was released to work without restriction but with caution.

On January 4, 1999, the claimant underwent an MRI of her hips and pelvis which was negative. An x-ray of her lumbar spine from the same date showed spondylotic (degenerative) changes of the lower lumbar spine and facet joint arthropathy (joint disease). The claimant also underwent a whole body bone scan on that date which showed increased uptake in the lower lumbar spine at approximately L4 and L5 levels involving posterior elements and pedicle at L4 and disc space at L5-S1.

On January 8, 1999, Dr. Holder wrote that the claimant complained that she was still symptomatic in her left hip on occasion after a day of increased activity. He diagnosed lumbar strain and lumbar spondylosis. Dr. Holder planned a CT scan and released the claimant to work without restrictions but with caution.

On January 12, 1999, the claimant underwent a CT scan which showed “mild broad based disc bulge at the L4-L5 level, with no evidence of disc herniation. No definite evidence of nerve root impingement appreciated radiographically. Moderate facet joint arthropathy present at the L4-L5 level.”

Dr. Holder wrote on January 21, 1999, that the claimant continued to complain of pain in her left hip and leg and lower back. He noted that the claimant had facet arthropathy at L4-5, L5-S1 according to a CT scan, which was consistent with x-rays, MRI and bone scan. Dr. Holder’s diagnosis was lumbar spondylosis and left piriformis. He released the claimant to return to work with a lifting limitation of 20-30 pounds. Dr. Holder stated that the claimant had reached maximum medical improvement. He imposed a 5% whole person impairment of the lumbosacral element pursuant to the Guides. Dr. Holder noted that the claimant might need anti-inflammatory medication and exercise including physical therapy in an intermittent basis due to the underlying condition.

The last time Dr. Holder examined the claimant was on January 21, 1999. He clearly recommended further treatment for the claimant’s compensable injury in the form of prescription medications, exercises and physical therapy on an intermittent basis. Dr. Holder, in fact, continued to prescribe the claimant with medications until respondents suspended the payment of benefits in October 1999. Additionally, after respondent suspended payment of benefits, the claimant sought relief from her family physician, who actually prescribed the claimant various medications and the claimant personally paid for this medical treatment. We find that the treatment the claimant received from her family physician was reasonably necessary to treat her compensable injury after the respondents terminated her access to authorized medical treatment.

Based on the above evidence, we also find that the claimant has proven by a preponderance of the evidence that she is entitled to additional medical treatment for her compensable injury. Specifically, we are persuaded by Dr. Holder’s recommendation of additional treatment when he last examined the claimant on January 21, 1999.

We also affirm the administrative law judge’s decision to grant a change of physician to Dr. Standefer. As noted by the administrative law judge, the claimant is yet to be examined by a specialist for her back problems to see if there might be additional treatment modalities that might improve her condition.

For the foregoing reasons, we find that the decision of the administrative law judge should be affirmed.

IT IS SO ORDERED.

_______________________________ ELDON F. COFFMAN, Chairman

Commissioner Humphrey concurs.

Commissioner Wilson concurs in part and dissents in part.

CONCURRING AND DISSENTING OPINION

I concur with the majority opinion that claimant is entitled to medical treatment specifically for her “left piriformis” condition. However, I must respectfully dissent from the majority opinion in regard to treatment of her back and to a change of physician to Dr. Standefer for care of her back. Claimant’s medical history indicates that she had a muscular injury causing pain in her piriformis and trochanter muscles and degenerative changes in her lumbar spine and facet joint disease. Certainly degenerative changes in the spine are not work-related, and claimant is not entitled to treatment at respondent’s expense for her degenerative conditions. Furthermore, because claimant has failed to demonstrate that her degenerative spine condition is work-related, a change of physician to Dr. Standefer for her back problems is unwarranted.

__________________________________ MIKE WILSON, Commissioner