CLAIM NO. E115617
Before the Arkansas Workers’ Compensation Commission
OPINION FILED AUGUST 27, 1997
Upon review before the FULL COMMISSION, Little Rock, Pulaski County, Arkansas.
Claimant represented by DONALD P. CHANEY, JR., Attorney at Law, Arkadelphia, Arkansas.
Respondent represented by DAVID LANDIS and MARK MAYFIELD, Attorneys at Law, Jonesboro, Arkansas.
[1] OPINION AND ORDER
[2] This case comes on for review by the Full Commission upon remand from the Arkansas Court of Appeals. The Court found that the Commission did not make clear the facts on which it based its finding that the claimant failed to prove by a preponderance of the evidence that the claimant’s carpal tunnel condition was related to his August 1991 compensable injury. The Court has remanded this case for more specific findings of fact that support the decision of the Full Commission. We find that the evidence does not support a finding that the claimant’s carpal tunnel condition was related to his August 1991 compensable injury.
[10] Evidence was presented that the claimant is able to oversee 110 acres of a farm and raise cattle. He is able to drive a tractor and operate a manual transmission pickup truck. In addition, the claimant is able to do maintenance on his and his wife’s vehicles as well. [11] The medical evidence does not support a finding that the claimant’s carpal tunnel condition is related to his compensable injury. The claimant has been treated by four highly competent physicians, none of which have been able to attribute the claimant’s carpal tunnel problems to his compensable injury. Dr. Tucker diagnosed the claimant with a peripheral nerve injury but could not tell if the injury was exacerbated by recent trauma. He stated that the problem appeared to be in the vicinity of the old scar. In addition, Dr. Hixson, the claimant’s primary treating physician, was unable to state how much of the claimant’s impairment rating was attributable to the old injury. Furthermore, Dr. Peeples was unable to relate the claimant’s carpal tunnel to a specific work-related injury. [12] After thorough consideration of all the evidence, we find that the evidence does not support a finding that the claimant’s carpal tunnel condition was related to his August 1991 compensable injury. Therefore, we affirm and adopt the opinion of the Administrative Law Judge finding the claimant sustained an accidental injury arising out of and in the course of his employment with Ray White Lumber Company; as a result of the injury the claimant was temporarily totally disabled until May 22, 1992, when his healing period ended as a result of the injury the claimant has sustained a permanent partial disability of 20% to the right upper extremity; and the claimant has failed to prove by a preponderance of the evidence that the carpal tunnel condition is related to the compensable injury. [13] We have carefully conducted a de novo review of the entire record herein and it is our opinion that the Administrative Law Judge’s decision is supported by a preponderance of the credible evidence, correctly applies the law, and should be affirmed. Specifically, we find from a preponderance of the evidence that the findings of fact made by the Administrative Law Judge are correct and they are, therefore, adopted by the Full Commission. [14] Thus, we affirm and adopt the decision of the Administrative Law Judge, including all findings and conclusions therein, as the decision of the Full Commission on appeal. [15] IT IS SO ORDERED.It is impossible to determine from examination exactly when the right carpal tunnel syndrome began and its exact etiology or the portion of the carpal tunnel attributable to the alleged incident in August of 1991.
ELDON F. COFFMAN, Chairman MIKE WILSON, Commissioner
[16] Commissioner Humphrey dissents.[17] DISSENTING OPINION
[18] I must respectfully dissent from the majority’s finding that claimant’s right-side carpal tunnel syndrome is not related to his compensable injury of August 13, 1991.
[20] After consulting Drs. Michael Ford, Paul Tucker, and Kevin McLeod, claimant eventually came under the care of Dr. Marcia Hixson, an orthopedic hand specialist. On November 18, 1991, Dr. Hixson expressed the opinion that claimant had “sustained an injury to the right median nerve somewhere in the forearm, most likely at the level of the pronator teres.” At that time, Dr. Hixson considered conservative management to be appropriate, but conceded that a median nerve release could eventually be necessary. Unfortunately, conservative treatment did not succeed, and claimant underwent a median nerve exploration on January 22, 1992, which ultimately proved to be of little benefit. [21] Dr. Hixson eventually assigned claimant a 20% impairment, though she could not successfully apportion the rating between claimant’s compensable injury and a pre-existing median nerve injury, discussed below. [22] Claimant had suffered a previous injury to the median nerve of his right arm in 1981, due to a laceration incurred from putting his arm through a plate glass window. This injury was not work-related, and claimant explained at the hearing that after its repair, he “could work with the best,” experienced no pain, and regained his strength and feeling. A January 6, 1982, letter from Dr. Edward H. Saer, who performed claimant’s median nerve repair in 1981, corroborates claimant’s testimony to a large extent:Yes, sir, we was working at a sawmill, and there is a green-chain that runs down the middle of a place here where the lumber comes off, and there’s guys working on both sides of the green-chain, and I was pulling lumber off that day, and I pulled a two-by-twelve or a one-by — I believe it was a one-by-twelve off, and when it went off, my feet slipped out, and I had a hold of the end of the board, and it went off the roller, and when it hit, it just sprang (sic) and popped my arm up in the air and just like a sling-shot. I had a hold of the end of the board when I went down, and it just popped me up in the air.
[23] Claimant returned to Dr. Hixson on October 7, 1993, with complaints of increased pain and weakness in the right hand. Owing to claimant’s presentation of symptoms, Dr. Hixson began to suspect the presence of right-side carpal tunnel syndrome, which was verified by electrodiagnostic studies on October 13, 1993. Dr. David A. Miles, who performed those studies, was aware of claimant’s 1981 injury but expressly stated that his CTS findings had “nothing to do with the old injury at the elbow.” [24] By November 22, 1993, Dr. Hixson considered claimant a candidate for carpal tunnel release provided he did not respond to continued conservative care over a six-week period. Claimant did not respond to such care and, on December 30, 1993, Dr. Hixson stated that “my impression is that Mr. Holloway’s condition is worsening and I suggested surgery to release his carpal tunnel.” [25] With regard to the causation of claimant’s ongoing right arm difficulty, specifically his CTS, Dr. Hixson has plainly attributed it to the work-related injury of August 13, 1991. In a March 11, 1994, letter to a representative of respondent employer, Dr. Hixson commented as follows:Mr. Holloway returned on January 5, 1982 now almost six months following his injury. He had returned to work since the last time I saw him and reports that he is able to climb ladders and do everything else without any difficulty. He is also happy because his movement in the index and middle fingers has improved although the thumb hasn’t changed any. He thinks he is getting some sensation back in his digits also.
[26] In a letter dated March 25, 1994, Dr. Hixson reaffirmed her foregoing opinion: “My October 7, 1992 (sic), letter does not indicate a new injury. It indicates an increase in his hand pain that he has always complained about. I still think this is all related to his injury of August 13, 1991.” (Because I cannot identify a letter from October 7, 1992, written by Dr. Hixson, I am persuaded that she is actually referring to her letter of October 7, 1993, wherein she raised the possibility of CTS.) [27] It is true that Dr. Earl Peeples reached a different conclusion following an IME he performed on August 2, 1994, to the effect that claimant’s CTS was more likely the result of a gradual process, rather than a specific injury. Even so, I believe that the opinions of Dr. Hixson, a hand specialist who has been claimant’s treating physician for some time, are entitled to greater weight than those of Dr. Peeples. Accordingly, based on Dr. Hixson’s opinion, corroborated by that of Dr. Miles, I would find that claimant’s right-side CTS is related to his compensable injury of August 13, 1991, and that respondents remain liable for it treatment. [28] Based on the foregoing, I must respectfully dissent from the majority’s finding that claimant’s right-side carpal tunnel syndrome is not related to his compensable injury. [29] PAT WEST HUMPHREY, CommissionerIn an attempt to clear up the confusion regarding Mr. Holloway’s right carpal tunnel syndrome, I have this opinion to offer. I believe this is a continuing problem as a result of his injury which was sustained on August 12, 1991. My examination of Mr. Holloway indicated that there was a problem with the median nerve and I thought it was most likely at the pronator teres in the right forearm. However, surgery really didn’t help Mr. Holloway and subsequent examinations, both in the clinic and by nerve conduction studies, showed that the problem most likely is at the right carpal tunnel. Unfortunately, many of these injuries are best diagnosed in hindsight.