CLAIM NO. D507962
LYNN NELSON TEAGUE, EMPLOYEE, CLAIMANT v. C J CHEMICAL COMPANY, EMPLOYER, RESPONDENT and ARGONAUT INSURANCE CO., CARRIER, RESPONDENT
Before the Arkansas Workers’ Compensation Commission
OPINION FILED JULY 10, 1995
Upon review before the FULL COMMISSION, Little Rock, Pulaski County, Arkansas.
Claimant represented by H. OSCAR HIRBY, Attorney at Law, Little Rock, Arkansas, and JAMES E. BLOUNT, III, Attorney at Law, Memphis, Tennessee.
Respondent represented by J.C. BAKER, JR., Attorney at Law, Little Rock, Arkansas.
Decision of Administrative Law Judge: Reversed in part and modified in part.
[1] OPINION AND ORDER
[2] This matter comes on for review by the Full Commission from the decision of the Administrative Law Judge filed on February 10, 1995 finding that claimant is entitled to additional benefits. After a de novo review of the record, we find that claimant failed to prove that he is entitled additional benefits related to alleged aggravations of his diabetes, benefits associated with dental difficulties or benefits associated with a second cervical surgery. Furthermore, due to the evidence, we reduce the amount of spousal nursing care benefits awarded by the Administrative Law Judge.
[3] It is undisputed that claimant sustained a serious compensable injury on June 8, 1985. Claimant also had preexisting diabetes. Claimant, presently, contends that he is entitled to a substantial number of additional benefits. For example, claimant contends that he is entitled to additional benefits for dental work, for total loss of vision and for other aggravations of his preexisting diabetes. Furthermore, claimant contends that he is entitled to payment of procedures and treatment for injuries to his eyes as a result of his retinopathies, for treatment to his feet due to ulcerations, for amputation of his right big toe which resulted from him stepping on a nail, for a second anterior cervical fusion performed in October of 1992, for spousal nursing care benefits, and for reimbursement of home modifications and items purchased purportedly needed for the treatment and adaptation of his injuries.
[4] Respondent controverts any additional benefits. Respondent is of the opinion that the need for dental work is the result of preexisting problems which are not related to his compensable motor vehicle accident. Respondent acknowledges that they accepted and initially paid for Dr. Glover’s treatment of claimant’s diabetes. Some of the complications are retinopathies and foot difficulties. However, Dr. Glover testified that as of August 20, 1986 claimant was no longer suffering from any complicating effects of his diabetes as a result of the automobile accident. Thus, respondent presently contends that they are not responsible for any complications of claimant’s diabetes subsequent to August 20, 1986. Also, respondent controverts any additional temporary total disability benefits associated with the second cervical procedure and any additional permanent impairment due to lost eyesight because the loss of vision is a consequence of claimant’s diabetes. Respondent controverts payment for a three wheeler and a four-wheeler, as well as, home modifications on the basis that they are not reasonably necessary and were made or purchased without any kind of recommendation by a physician. Additionally, respondent contends that claimant is not entitled to any reimbursement for spousal nursing care prior to the date that they were notified that nursing care was being rendered.
[5] Claimant contends that he is entitled to numerous benefits because the motor vehicle accident aggravated his diabetes. However, a preponderance of the evidence shows that any aggravation of claimant’s diabetes is causally related to the motor vehicle accident subsided in August of 1986. Therefore, we reverse in part and modify in part the decision of the Administrative Law Judge.
[6] In January of 1971, claimant was diagnosed with diabetes. He was seen by Dr. Wooten in Memphis, Tennessee. At that time, the medical history indicated that claimant was overweight and a heavy beer drinker. After being diagnosed as diabetic, Dr. Wooten recommended a diet, insulin twice a day, and advised claimant on diabetic care including general diet instructions, the importance of keeping doctors’ appointments and conducting regular urine tests. Dr. Wooten also told claimant to see a physician every six months. Claimant did not follow Dr. Wooten’s instructions. In fact, after a February 15, 1971 appointment, claimant never returned to Dr. Wooten.
[7] The next time claimant saw a physician for his diabetes was in November of 1975. At that time, claimant saw Dr. Ethridge. Dr. Ethridge noted that claimant was not maintaining his insulin protocol and that claimant was considerably overweight. Claimant admitted that he was uncooperative and noncompliant with the treatment plan that had been recommended by Dr. Wooten.
[8] In February of 1980, claimant was treated by Dr. Stroud. At this time, claimant was treated for abscesses that had formed on his buttock. Dr. Stroud noted that claimant had failed to adequately control his weight and diabetes.
[9] In February of 1985, Dr. Magie first saw claimant for visual problems. Dr. Magie noted that it had been over three years since claimant had had a diabetic check. At that time, it was recommended that claimant undergo a diabetic evaluation. In February of 1985, Dr. Magie testified that claimant had developed diabetic retinopathies in both eyes.
[10] Claimant began treatment with Dr. Ross for diabetes. In April of 1985, claimant went to Dr. Ross with lesions forming on his right lower leg. In April of 1985, Dr. Ross noted that claimant had decreased pulse and sensation in his right foot and diagnosed claimant as having peripheral neuropathy.
[11] In May of 1985, claimant was examined by Dr. Glover, an endocrinologist. Dr. Glover noted that subsequent to claimant’s diagnosis of being diabetic, claimant did not do anything about his diabetes and did not take any particular care of himself. Dr. Glover on the initial visit noted the onset of several complications due to the diabetes including visual changes, leg numbness, sweating after eating, and urinary problems. The aforementioned indicates that all of claimant’s complaints for which he presently complains preexisted the June 6, 1985 motor vehicle accident.
[12] The Administrative Law Judge found respondent responsible for all the complications and treatments. However, as the above-referenced shows, claimant was well on his way to having all of these difficulties prior to the motor vehicle accident. Claimant was a noncompliant, poorly controlled diabetic for at least 14 years prior to the compensable accident. Claimant was developing several end stage complications of his diabetes prior to June 6, 1985. In short, the evidence does not show that claimant’s complications are the natural and probable consequence of his compensable injury or that they are causally related to the motor vehicle accident.
[13] There is insufficient evidence that claimant’s automobile accident caused any long-term aggravation or significant acceleration of claimant’s diabetes. Claimant was well on his way to have these difficulties prior to the accident and these conditions were brought about because of claimant’s noncompliance with his instructions for diabetic care prior to the motor vehicle accident.
[14] Most persuasive testimony is that the plethora of ailments from which claimant is now suffering is not causally connected to his motor vehicle accident comes from Dr. Glover. Dr. Glover is a well-respected endocrinologist. His opinion is that claimant’s difficulties, the diabetic neuropathies which affects his lower extremities and the retinopathies which effect his eyes, are complications of diabetes. These complications are caused by the high blood sugars which create a toxic effect in the body. Due to claimant’s long-term neglect of his diabetes before the accident, the toxic effect on claimant’s body was significant.
[15] Prior to the motor vehicle accident, claimant did not take care of his diabetes. In fact, it appears that after the motor vehicle accident, claimant was forced to get control of his diabetes. The medical evidence indicates that subsequent to the motor vehicle accident, claimant had lower blood sugar levels which lessens the toxic effect of the diabetes. Furthermore, Dr. Glover specifically states that through April of 1986, claimant’s diabetes stabilized and claimant was in control. As of August 20, 1986, Dr. Glover stated that with the exception of claimant’s ophthalmological problems, claimant was no longer suffering from any residual effects of the automobile accident with regards to his diabetes or diabetic complications.
[16] Dr. Glover’s opinion is somewhat supported by Dr. Ward’s opinion. Although Dr. Ward, in May of 1992, disagreed with Dr. Glover in regards to whether the car accident aggravated the preexisting retinopathy, he did agree with Dr. Glover that any aggravating effect on the diabetes due to the car accident had ended as of August of 1986. With the sole exception of the retinopathies, there is no single medical opinion in this record which contends that claimant’s car wreck in anyway is responsible for his diabetes or any diabetic complication beyond August of 1986. Thus, the Administrative Law Judge erred in determining that any diabetic complication from which claimant continued to suffer beyond August of 1986 is an aggravation due to his compensable accident. Any causal connection is based purely upon speculation. The Administrative Law Judge has wrongly forced respondent to be responsible for all complications of claimant’s diabetes.
[17] One complication that is clearly not related to the motor vehicle accident is renal failure. Dr. Glover specifically denied that the automobile accident play any role in claimant’s renal failure. In fact, there does not appear to be a single medical opinion in the record that says the renal failure is a compensable consequence of the motor vehicle accident. Not only is there not a close temporal relationship between the automobile accident and the onset of the renal problems and failure, there is no logical connection between the two.
[18] The Administrative Law Judge also erred in determining that claimant’s retinopathies and vision problems are due to an aggravation of his diabetes which resulted from the motor vehicle accident. The evidence shows that claimant began suffering from retinopathies and vision problems prior to the June 6, 1985 accident. In fact, Dr. Magie testified that he saw claimant in February of 1984 because of iritis. The Administrative Law Judge equates this with pinkeye. However, iritis is an inflammation of the iris which can have many etiologies. Dr. Magie explained that iritis is typically seen in advanced cases of diabetes.
[19] In February of 1985, Dr. Magie noted that claimant was having microaneurysm, hemorrhages and exudates in both eyes. At this time, it was clear that claimant’s eye condition had worsened since the examination in 1984 but prior to the motor vehicle accident. In February of 1985, the doctor diagnosed claimant with diabetic retinopathy. It appears that claimant had a preproliferation of findings prior to the motor vehicle accident.
[20] Dr. Magie testified that trauma can cause a progression of the retinopathy but the trauma must created some extra pressure in the eye itself. There is insufficient evidence in the record that there was any increase in eye pressure as a result of the motor vehicle accident. Claimant’s initial history after the motor vehicle accident noted that his eyes were normal and there were no difficulties with his eyes at that time.
[21] Dr. Magie also testified that if claimant was unable to properly care for his diabetes after the motor vehicle accident, then that would cause an aggravation of the retinopathy. However, as stated, subsequent to the motor vehicle accident, claimant’s diabetes was under better control than it was before the motor vehicle accident.
[22] There is insufficient evidence to establish a causal connection between claimant’s retinopathies and his total loss of vision and the motor vehicle accident. The evidence as to causal connection offered by the endocrinologist is not as persuasive as that from the ophthalmologist. Furthermore, the only physician who saw claimant before the car wreck and after the car wreck was Dr. Magie, the ophthalmologist. There is insufficient evidence in the record that claimant’s retinopathy or additional loss of vision is a compensable consequence of claimant’s work-related injury.
[23] Claimant was also beginning to suffer from a loss of sensation due to peripheral neuropathy prior to the motor vehicle accident in June of 1985. As of April of 1985, Dr. Ross had noted claimant’s peripheral neuropathy. However, the earliest indication of any foot ulceration is in September of 1988. The foot ulceration was diagnosed as a complication of diabetes. However, this is well past the August 20, 1986 date that Dr. Glover established that the end of any residual effect from the car wreck.
[24] Also, it is obvious that many of claimant’s foot problems, including the amputation of his right great toe, are the result of claimant stepping on a nail at deer camp in December of 1990. The evidence simply does not indicate that the misstep is causally related to the work-related injury.
[25] Claimant developed toe and foot problems after stepping on a nail in December of 1990. It is acknowledged that after stepping on the nail, claimant developed gangrene and had to have his big toe amputated. It is not rational to find that this misstep is somehow causally connected to a motor vehicle accident in 1985.
[26] Claimant contends that the reason he stepped on the nail is because he could not see the nail. He states he could not see because the motor vehicle accident aggravated his eye problems. Claimant also stated that he stepped on the nail because of a lack of feel in his appendage. In fact, he contends that he did not even know that he had stepped on the nail until somebody told him about it. However, neither of these stories is sufficient to establish a causal connection. To find a causal connection based on either theory, one must presume that if claimant had had normal vision or better sensory perception, he would have never stepped on the nail. This is premised upon sheer speculation.
[27] Additionally, the Administrative Law Judge finds that the claimant’s current ulcerations are due to a change in weight bearing. This is in error. Claimant had several right leg fractures as a result of his motor vehicle accident. Claimant contends that as a result of this, he has an altered gait which led to excess weight bearing on the left leg. If this is followed to its logical conclusion, one would anticipate seeing ulcers only on the left foot. However, claimant’s foot ulcers have occurred on both feet. There is insufficient evidence that any of the ulcerations are causally connected to the altered gait.
[28] Claimant is suffering from the foot ulcerations and other lower appendage difficulties because of the advanced neuropathies. Claimant was chronically overweight for 14 years prior to the motor vehicle accident and was neglectful of foot care which, in the case of diabetics, has serious consequences.
[29] A myelogram in January of 1986 found that claimant had a large defect at the C3-4 level and a small defect on the right. At that time, claimant was found to have a small bulge at the C4-5 level without significant nerve root impingement. In February of 1986, claimant underwent compensable cervical surgery. Claimant had remarkable improvement by following the procedure. It appear that claimant had a total resolution of numbness, pain and hyperesthesia.
[30] Eventually, in 1992, claimant underwent a subsequent anterior fusion. The Administrative Law Judge found the second surgery compensable. However, this determination is not supported by a preponderance of the credible evidence.
[31] The record clearly reflects that in October of 1986, claimant purchased a three-wheeler and in 1990, he purchased a four-wheeler. Claimant admittedly used these to get about his land and visit neighbors, etc. Claimant, in his deposition, indicated that he had multiple accidents by turning over his three-wheeler. He testified that the three-wheeler rolled over on him more than 20 occasions. He said he was fortunate not to break any bones. Claimant was admitted to the hospital in October of 1992 with a history that notes that claimant had, for the past six weeks,
developed numbness and tingling in both arms. A preponderance of the credible evidence does not show that claimant’s second neck problems are related to the 1985 motor vehicle accident.
[32] On the date of the hearing, claimant began to contend that he was entitled to spousal nursing care from September 13, 1985 through December 6, 1985 at $6.00 per hour for three hours a day. Respondent objected and claimant withdrew this claim. However, the Administrative Law Judge went ahead and made an award. Respondent has been deprived of an opportunity to conduct discovery and cross examine. The decision is an error especially in light of the fact that this claim was specifically reserved. Thus, the award from spousal nursing benefits from September 13, 1985 through December 6, 1985 is reversed.
[33] Additionally, there must be a modification of the award for spousal nursing care. Claimant’s wife did perform nursing services beyond those included in spousal care. Yet, the amounts awarded by the Administrative Law Judge are excessive. Claimant has proven that approximately three hours per day of spousal nursing care was performed by Mrs. Teague, claimant’s spouse for the period of time from July 3, 1985 to September 12, 1985. Furthermore, Ms. Teague should be paid at minimum wage, not at $6.00 per hour. Although the care rendered by her required specialized knowledge, it was not overly complicated.
[34] Lastly, the award of payment for medical apparatus and home modification is an error. The Administrative Law Judge required respondent to pay for a three-wheeler, a four-wheeler, a walker, a page magnifier, widening the doors, installing ramps, painting the interior of the home with lighter colors, modifying a bathroom and for the installation and cost of a hot tub. We find that respondent is not liable for any of these.
[35] The painting of the home and the page magnifier are causally related to claimant’s loss of vision. The loss of vision is not compensable. Thus, these devices should not be found compensable.
[36] Furthermore, the only item recommended by a physician was the hot tub. However, even this, was made after claimant had purchased the hot tub.
[37] Respondent was never notified that any of the aforementioned items or improvements were needed. Because claimant went ahead and had the modifications done or purchased the items, respondent was deprived of the ability to find less expensive but equally efficient alternatives. Respondent was also deprived of an opportunity to determine whether they are reasonable, related and necessary for the treatment of claimant’s work-related injury.
[38] Claimant contends that he is entitled to dental care. Dr. Flanagin stated that he felt that the trauma from the accident
may have caused the problem with his teeth. However, this statement does not constitute a preponderance of the evidence. Although claimant contends that he had no difficulties with his teeth prior to the motor vehicle accident, Dr. Flanagin indicated that several teeth had been previously restored. In fact, shortly before the automobile accident, claimant had undergone dental procedures for teeth extractions. Claimant has failed to show by a preponderance of the credible evidence that the automobile accident in anyway injured or aggravation his teeth.
[39] We are of the opinion that the Administrative Law Judge erred in awarding claimant additional temporary total disability benefits. Claimant contends that he is entitled to additional temporary total disability benefits associated with the second cervical neck surgery. However, as stated, the second cervical surgery is not causally connected to his work-related injury and, thus, claimant is not entitled to any additional temporary total disability benefits. As to the other times claimant contends that he is entitled to temporary total disability benefits, respondent received no notice of these claims. Thus, respondent has been deprived or an opportunity to conduct investigation or discovery on these issues. The Administrative Law Judge erred in finding claimant is entitled to additional temporary total disability benefits.
[40] Claimant is not entitled to any additional temporary total disability benefits or any of the other benefits sought except for a modification in the award of spousal nursing care. Therefore, we reverse in part and modify in part the decision of the Administrative Law Judge.
[41] IT IS SO ORDERED.
JAMES W. DANIEL, Chairman ALLYN C. TATUM, Commissioner
[42] Commissioner Humphrey dissents.
