CLAIM NO. E115617
Before the Arkansas Workers’ Compensation Commission
ORDER FILED AUGUST 30, 1999
Upon review before the FULL COMMISSION, Little Rock, Pulaski County, Arkansas.
Claimant represented by DON B. CHANEY, Attorney at Law, Arkadelphia, Arkansas.
Respondent represented by MARK MAYFIELD, Attorney at Law, Jonesboro, Arkansas.
[1] ORDER[2] This case comes on for review by the Full Commission upon remand from the Arkansas Supreme Court. The Court noted several inconsistencies within the Commission’s opinion. The Court opinion states:
[3] Another discrepancy exists within the record. The Commission affirmed and adopted the Administrative Law Judge’s opinion as its own. The Administrative Law Judge made the following statement in the opinion: “The claimant did not seek medical attention after his visit to Dr. Hixson on May 22, 1992, until he returned on October 7, 1993.” However, the Court noted that the record showed that the claimant had returned to Dr. Hixson on August 28, 1992, September 15, 1992, October 5, 1992, November 2, 1992, March 12, 1993, and September 2, 1993. The Commission’s statement was a statement within the opinion, not a finding of fact. However, the sentence reflects an inaccurate statement that was merely an oversight by the Commission. The Commission apologizes to the Court for the oversight. [4] With the discrepancies cleared up, we find that the claimant’s carpal tunnel syndrome is not attributable to his compensable injury. [5] The claimant sustained an injury to his right arm in 1981, when he put his arm through a plate glass window. This was not a work related injury. The claimant lacerated the elbow flexion crease cutting both the brachial artery and vein and lacerating the median nerve. Dr. Parnell performed an arterial repair and Dr. Edward Saer repaired the nerve. Dr. Saer opined that the claimant would never have a “totally normal hand.” [6] The claimant testified that he recovered from the 1981 injury and was able to work at several labor intensive jobs. However, the claimant admitted that his hand was not fully recovered when he was released from Dr. Saer’s care. [7] On August 13, 1991, while working for the respondents, the claimant injured his right arm when a board from a roller sprang up and popped his arm into the air causing a sharp pain. The claimant did not seek medical attention until August 26, 1991. The respondents accepted the injury as compensable. The claimant now contends that his current carpal tunnel problems were caused by the August 13, 1991, injury. The respondents contend that claimant’s arm condition is not related to the compensable injury and that the claimant is not entitled to additional temporary total disability benefits. [8] On August 26, 1991, the claimant was examined by Dr. Michael Ford. The claimant failed to mention his prior history of arm problems. Dr. Ford referred the claimant to Dr. Paul Tucker, a neurologist. Dr. Tucker diagnosed the claimant with a peripheral nerve injury and stated that he could not tell if the injury was exacerbated by recent trauma. Dr. Tucker opined that the problem appeared to be in the vicinity of the old scar. In November of 1991, the claimant sought treatment from Dr. Marcia Hixson. Dr. Hixson diagnosed an injury to the median nerve. She performed surgery on the claimant on January 22, 1992, to release the nerve. [9] In June of 1992, Dr. Hixson stated that the claimant had plateaued from his injury and from the surgery. Dr. Hixson assigned the claimant a 20% impairment rating of the right upper extremity. However, she was unable to state how much of that impairment was new, how much was an aggravation of an old injury, or how much was the old injury itself. [10] The claimant was able to perform farm work which included lifting sacks of feed and driving a tractor. In September of 1992, he fell off of a tractor striking the ground so hard he was “addled.” The claimant was treated by Dr. Earl Peeples for a back injury. [11] The claimant was diagnosed with carpal tunnel syndrome by Dr. Hixson in October of 1993. In addition, the right index finger had progressively drawn inward. This is also known as a claw finger. Dr. Peeples performed an independent medical examination on the claimant, wherein he noted that the claimant relaxed the claw finger when he was distracted. Dr. Peeples opined that the claimant had carpal tunnel syndrome, however he was unable to determine if it related to a specific injury at work or to slow development over a period of time. Dr. Peeples stated that it was doubtful that the carpal tunnel was caused by a specific injury at work. Dr. Peeples concluded:Rather than this Court attributing any significance to or drawing any conclusions from these perceived inconsistencies, we consider it more appropriate to remand this case to the Commission to examine its findings and reconcile the discrepancies.
One of the inconsistencies that the Court perceived is contained in the following sentence: “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.” The Court stated that it appeared that the competent physicians referred to were Drs. McCloud, Ford, Tucker, and Hixson. Although the Court noted that there were inconsistencies which respect to the four doctors, for the record this statement refers to Drs. Ford, McCloud, Tucker, and Peeples. Although Dr. Peeples did not treat the claimant, he did perform an independent medical evaluation of the claimant on August 2, 1994. Therefore, the statement should have said, “The claimant has been treated and examined by four highly competent physicians, including Drs. Ford, McCloud, Tucker, and Peeples, none of which have been able to attribute the claimant’s carpal tunnel problems to his compensable injury.”
[12] 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. [13] The medical evidence does not support a finding that the claimant’s carpal tunnel condition is related 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. 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. Dr. Peeples was unable to relate the claimant’s carpal tunnel to a specific work related injury. [14] Accordingly, after considering all the evidence, we find that the claimant has failed to prove by a preponderance of the evidence that his carpal tunnel condition was related to his August 1991 compensable injury. IT IS SO ORDERED. [15] _______________________________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 opinion finding that claimant has failed to prove by a preponderance of the evidence that his carpal tunnel condition is related to his August 1991 compensable injury. [19] I have reviewed the directions issued upon remand and choose to renew the arguments raised in my dissent of August 27, 1997, made in response to the now remanded majority opinion. I believe that the conclusion that claimant sustained a compensable injury is even stronger when we consider the discrepancy cited by the Court regarding claimant’s doctor visits between May 22, 1992 and October 7, 1993. I continue to believe that the opinion of Dr. Hixson should be given significant weight and conclude that the Court recognized that significance in its critique of the characterization of medical opinions in our earlier decision. [20] After suffering his compensable injury on August 13, 1991, claimant came under the care of Dr. Hixson who assigned claimant a 20% impairment rating. Pursuant to a continuing course of treatment claimant was seen by Dr. Hixson on October 7, 1993, for increased pain and weakness in his right hand. Dr. Hixson began to suspect the presence of right-side carpal tunnel syndrome which was later confirmed by electro-diagnostic studies. [21] Dr. Hixson has plainly attributed the cause of claimant’s carpal tunnel syndrome to his August 13, 1991, injury. It is true that Dr. Peeples reached a different conclusion following an IME in August of 1994 to the effect that claimant’s carpal tunnel syndrome was more likely the result of a gradual process rather than a specific injury. Even so, I believe that the opinion of Dr. Hixson, a hand specialist who was the treating physician, is entitled to greater weight than the opinion of Dr. Peeples. Accordingly I would find that claimant’s right sided carpal tunnel syndrome arose out of his compensable injury of August 13, 1991, and that respondents are therefore liable for it’s treatment. [22] ______________________________ PAT WEST HUMPHREY, Commissioner