CLAIM NO. E513234
MARGARITO R. RAMIREZ, EMPLOYEE, CLAIMANT v. PILGRIM’S PRIDE CORPORATION, SELF-INSURED EMPLOYER, RESPONDENT Before the Arkansas Workers’ Compensation Commission
OPINION FILED MARCH 9, 1998
Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas.
Claimant represented by the HONORABLE S. HUBERT MAYES, JR., Attorney at Law, Little Rock, Arkansas.
Respondents represented by the HONORABLE ROBERT D. TRAMMELL, Attorney at Law, Little Rock, Arkansas.
Decision of the Administrative Law Judge: Remanded.
[1]
ORDER [2] The administrative law judge to which this case was assigned entered an opinion on July 23, 1997. In that opinion, the administrative law judge held that the claimant failed to establish that he was entitled to benefits for a venous insufficiency condition in his right leg. After conducting a denovo review of record in this case, as well as the appellate briefs filed by the parties herein, we find that this matter should be remanded to the administrative law judge for reconsideration. [3] The claimant sustained an admittedly compensable injury to his right leg in late July 1995. This injury occurred when a metal cart tipped over and fell on the claimant’s leg. As a result of this injury, the claimant sustained a severe cut to his leg which became infected. However, even after the wound and infection had healed, the claimant continued to complain of pain, swelling, and related problems in his leg. [4] The claimant was eventually seen by Dr. Robert Dunn, a general surgeon in Nashville, Arkansas. Dr. Dunn diagnosed the claimant as suffering from venous insufficiency. Later, at the direction of the respondents, the claimant was seen by Dr. Hugh Burnett, a vascular surgeon in Little Rock, Arkansas. Dr. Burnett stated that he found no evidence of any circulatory impairment or disability in the claimant’s right leg. Dr. Burnett also questioned the treatment modalities prescribed by Dr. Dunn. [5] No hearing was held in this case and the matter was submitted to an administrative law judge based upon a stipulated record. However, apparently because of the diametrically opposed diagnoses of Dr. Dunn and Dr. Burnett, the administrative law judge directed the claimant to undergo an independent medical examination by Dr. Edward Loebl. [6] The administrative law judge denied the claimant’s request for benefits based upon any venous problems in his leg. In reaching that conclusion, the administrative law judge summarized the medical opinions in this case as follows:
The claimant’s treating general practitioner [Dr. Dunn] believes that the claimant’s current symptomology is related to his compensable injury but the two vascular surgeons [Dr. Burnett and Dr. Loebl] do not.
[7] The threshold causation issue in this case on which the administrative law judge denied benefits actually consists of two inter-related questions: (1) What is the nature of the abnormality causing the claimant’s symptoms? and, (2) Has the claimant met his burden of proof in establishing a causal relationship between his current abnormality and his admittedly compensable injury sustained in July of 1995? [8] Dr. Dunn has opined that the claimant’s symptom-producing abnormality is a venous insufficiency and Dr. Dunn has opined that this abnormality is casually related to the claimant’s work-related injury. Dr. Burnett opined that he did not find any evidence of vascular insufficiency, and even if he were to assume that the claimant is experiencing a vascular insufficiency, that the claimant’s injury in July of 1995 was not the major cause of the venous insufficiency. Somewhat contrary to the administrative law judge’s assertion of Dr. Loebl’s findings, we understand Dr. Loebl’s June 26, 1997 report and cover letter, taken together, to indicate that Dr. Loebl ascertained that the claimant is
experiencing a venous insufficiency, but that Dr. Loebl was not willing to express an opinion on the causation issue in this case. In this regard, Dr. Loebl’s June 26, 1997 report states in relevant part:
Finally, the patient does have venous valvular incompetence of the right popliteal and posterior tibial veins. This certainly could be a consequence of the traumatic injury to his leg and might be contributing somewhat to his symptomatology. On the other hand, it is impossible to tell whether this valvular incompetence antedates the patient’s injury or whether it is in any way related to it.
[9] Dr. Loebl’s June 26, 1997 cover letter states in relevant part:
His right lower extremity does have evidence of venous valvular incompetence. There is no means to determine whether this finding predates his injury.
[10] Moreover, we understand Dr. Loebl’s report and cover letter as corroborating of Dr. Dunn’s diagnosis that the claimant’s symptom-causing abnormality is a vascular insufficiency, and we disagree with the administrative law judge’s finding that Dr. Loebl concluded that the claimant’s current symptomology is not
causally related to the claimant’s work-related injury. To the contrary, we understand Dr. Loebl’s correspondence as declining to state an opinion on the causation issue, beyond noting that the claimant’s current abnormality could be a consequence of the traumatic injury. We also understand Dr. Loebl’s correspondence to indicate that he did not feel that he was in a position during the IME to ascertain whether a causal relationship did in fact exist. [11] In light of our interpretation of Dr. Loebl’s correspondence, we see no basis for remanding this case to obtain Dr. Loebl’s deposition, as the claimant requests. Dr. Loebl’s report corroborates Dr. Dunn’s diagnosis of a vascular insufficiency, and Dr. Loebl’s report explains the diagnostic testing from which he specifically diagnosed a venous valvular incompetence. Since Dr. Loebl has not rendered an opinion on the causation issue, and since Dr. Loebl’s report and cover letter indicate that he willnot render an opinion on causation beyond stating that the claimant’s current problems could be related to the claimant’s trauma, we find that additional medical opinions from Dr. Loebl would not change the outcome of this case. Therefore, the claimant’s request to remand this case for the purpose of taking Dr. Loebl’s deposition is respectfully denied. [12] However, the claimant also asserts that there is a conflict of interest in the testimony of Dr. Burnett, in that Dr. Burnett is the brother-in-law of the respondents’ counsel. Significantly, the respondents do not deny the existence of this relationship but, instead, argue that it should be disregarded since the claimant became aware of the relationship prior to the administrative law judge’s decision. [13] In our opinion, the relationship between respondent’s counsel and Dr. Burnett is sufficiently important to call into question the weight to be accorded Dr. Burnett’s opinions and testimony. Also, regardless of precisely when the claimant became aware of this relationship, it is apparent from our review of the record that the administrative law judge was not aware of it at any time prior to his decision. Since the administrative law judge’s decision relied extensively upon the report and findings of Dr. Burnett, and since we do not have an adequate record on this issue from which to conduct a de novo review, we believe that is appropriate to remand this case to the administrative law judge so that he can develop a record on the alleged relationship between Dr. Burnett and the respondents’ attorney and reconsider his decision in light of the relationship that existed between respondent’s counsel and Dr. Burnett. [14] We also note from the record that there appears to be some confusion between the parties as to whether the question of the extent of any permanent disability suffered by the claimant was to be considered by the administrative law judge. The administrative law judge is specifically directed to obtain a written statement from each of the parties indicating whether or not this issue is in fact submitted for consideration. [15] For the reasons set out above, this case is hereby remanded to the administrative law judge so that he may determine the appropriate weight and credibility to be given to Dr. Burnett’s report in light of the relationship between the doctor and respondents’ counsel, and to review his decision in light of such reconsideration. [16] IT IS SO ORDERED.
ELDON F. COFFMAN, Chairman PAT WEST HUMPHREY, Commissioner
[17] Commissioner Wilson dissents.