WILLIAMS v. ARKANSAS KRAFT CORPORATION, 1996 AWCC 165

CLAIM NO. D707522

THOMAS J. WILLIAMS, EMPLOYEE, CLAIMANT, v. ARKANSAS KRAFT CORPORATION, EMPLOYER, RESPONDENT, and FIREMAN’S FUND, INSURANCE COMPANY, RESPONDENT

Before the Arkansas Workers’ Compensation Commission
OPINION FILED AUGUST 8, 1996

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

Claimant represented by THOMAS H. McGOWAN, Attorney at Law, Little Rock, Arkansas.

Respondents represented by MICHAEL L. ALEXANDER, Attorney at Law, Little Rock, Arkansas.

Decision of Administrative Law Judge: Affirmed in part and reversed in part.

[1] OPINION AND ORDER
[2] An Administrative Law Judge entered an opinion and order in the above-captioned case on August 28, 1995, finding that bi-weekly chiropractic visits were reasonable and necessary treatment for claimant’s compensable back injury, and that claimant was entitled to a continuation of such treatments. Respondents appeal from that opinion and order, contending that continued chiropractic treatments are not reasonable and necessary. Claimant has cross-appealed, seeking a clarification of whether chiropractic treatments rendered after the date of controversion are compensable in addition to the continued (prospective) treatments awarded by the Administrative Law Judge.

[3] Following our de novo review of the entire record, we find that continued indefinite chiropractic manipulations, beyond those permitted by this Opinion and Order as discussed below, are not reasonable and necessary treatment for claimant’s compensable injury. We thus reverse this portion of the Administrative Law Judge’s decision. However, we also find that respondents are liable for those chiropractic treatments rendered after the date of controversion up until the date of this Opinion and Order. We thus affirm the remainder of the Administrative Law Judge’s decision which is not inconsistent with our findings herein.

[4] In addition, we find that claimant is entitled to a period of six-months of additional treatment, to be performed by a mutually agreed-upon provider, the purpose of which will be to assist claimant in phasing out ongoing chiropractic treatment and physical therapy and replacing them with a permanent self-managed program. Any treatment beyond the six month period, which shall be deemed in effect upon the receipt of this Opinion and Order by both parties, must be documented with medical evidence reflecting the necessity of such treatment.

[5] Claimant sustained an admittedly compensable injury on December 10, 1983. A lengthy course of conservative treatment failed to measurably ameliorate its effects, and Dr. John Adametz performed a lumbar laminectomy in February, 1986. That procedure revealed a disc herniation at the L5-S1 level (left side), verifying the results of a CT scan in 1985.

[6] Unfortunately, claimant’s surgery failed to completely resolve his difficulties, and he began to experience numbness in his left foot and leg following a return to light duty in early 1987. Claimant continued to be followed by Dr. Adametz until the latter’s retirement, at which time his care was transferred to Dr. Ray Jouett. Dr. Jouett also retired in 1992, and Dr. Ron Williams took over the management of claimant’s ongoing problems.

[7] Claimant also began receiving chiropractic treatments from Dr. Gus Reynolds in 1987, and continued with them until he retired as well. Thereafter, claimant began seeing another chiropractic physician, Dr. James Ennis, in January, 1995. He has received continuing treatment from Dr. Ennis since that time. Apparently, claimant’s only medical (non-chiropractic) treatment at the present time consists of pain medication and muscle relaxers — both prescription and over the counter. Claimant’s job duties are varied, but do include a considerable amount of manual labor.

[8] Respondent accepted claimant’s injury and surgery as compensable, and accordingly paid for related medical expenses, temporary total disability, and a 10% permanent impairment. Claimant’s chiropractic visits were also paid for until May 3, 1993, at which time respondents controverted payment for further treatments on the grounds that a medical report from Dr. Ted Honghiran established that they were not reasonable and necessary. Because claimant’s injury occurred prior to July 1, 1993, Act 796 of 1993 is inapplicable to this claim.

[9] Our review of the record persuades us that continued indefinite chiropractic care is not reasonable and necessary treatment for claimant’s compensable injury. Instead, while chiropractic manipulations have clearly offered claimant some benefit in the past, the evidence before us indicates that ongoing treatments will be of minimal value.

[10] Respondents sent claimant to Dr. Ted Honghiran on April 20, 1993, for an evaluation of his continuing difficulties. While Dr. Honghiran questioned regular chiropractic treatments, he stopped short of recommending the unilateral termination of such treatments which respondents eventually implemented:

Occasional chiropractic treatment or physical therapy would be reasonable if he has a flare-up of muscle spasms and severe pain. I don’t think he needs the regular treatment he has been receiving.

[11] We note that Dr. Honghiran’s report was procured by respondents and was based upon a one-time office visit. However, claimant also received an independent medical examination upon an order of the Commission, which Dr. Robert G. Valentine, Jr., performed on June 26, 1995. Dr. Valentine’s report addresses claimant’s situation at length:

It is well known that physical therapy must be limited due to the fact that patients in essence become “addicted” to therapy itself. The modalities are pleasant and comfortable and effective in reducing some spasm and discomfort. I note that, according to Mr. Williams and apparently according to his records, he has never been taught adequate stretching for the muscle spasms and has relied upon chiropractic manipulation and the physical therapy modalities of heat, and more recently, galvanic stimulation.
The chiropractic manipulations will result, in effect, in acute stretching of some of the lumbar musculature which should, anatomically speaking, result in decreased discomfort.

[12] In light of his apparent concern that claimant may have become “addicted” to chiropractic manipulations and physical therapy modalities, Dr. Valentine recommended that:

Mr. Williams should be taught and supervised in adequate stretching maneuvers. He should be tapered off his physical therapy and manipulation over a period of approximately six months. This will take time to do as he is, in effect, dependent on them at the present time, not having education or experience in more appropriate long term methods of reducing the back spasm and reconditioning the abdominal musculature in particular, to provide additional lumbar support (strengthening the abdominal musculature in effect provides the same effect as a “lumbar corset”). Tapering of the physical therapy, I think, will probably take about six months or so. Tapering of the chiropractic manipulation, I think, should be occurring over the same period of time.

[13] Based on the reports of Drs. Honghiran and Valentine, we specifically find that ongoing chiropractic or physical therapy treatments for an indefinite period of time would be unreasonable and unnecessary treatment for claimant’s compensable injury. However, we also find, based upon Dr. Valentine’s foregoing recommendation, that a preponderance of the evidence indicates that complete termination of all therapy would not be appropriate. In turn, we find that claimant is entitled to the additional six months of treatment which Dr. Valentine believes will be necessary to “taper” claimant off of his present therapy. Respondents and claimant are thus hereby directed to implement the recommendations of Dr. Valentine by way of a mutually agreed-upon provider, with the six-month period deemed to be in effect upon receipt of this Opinion and Order by both parties.

[14] Concerning claimant’s cross-appeal, we specifically find that respondents are liable for all chiropractic treatments rendered prior to the date of this Opinion and Order. While we do not find continued regular chiropractic treatments for an indefinite period of time to be reasonable or necessary, the preponderance of the evidence shows that such treatments have played an important role in claimant’s rehabilitation to date.

[15] We note first of all that even Dr. Honghiran allowed for “occasional chiropractic treatment” in the event claimant experienced an episode of severe spasm or pain. Even more instructive on this issue are Dr. Williams’ communications with claimant’s chiropractic providers:

As you know, this gentleman had surgery in 1986, by Dr. John Adametz for left leg pain. That was done at the L5-S1 level. That provided him considerable relief but he’s (sic) always had some difficulty on and off with his leg. Despite that, he’s (sic) been able to continue working. Your treatment has always provided him considerable benefit. (from a March 17, 1993, letter to Dr. Reynolds) (emphasis added).
Mr. Williams was by today for his evaluation. He has not really changed and still has a lot of difficulty with pain and numbness in the leg if he does not see you once or twice a week. (from an October 20, 1993 letter to Dr. Reynolds) (emphasis added).
Mr. Williams was by today. He really has not changed a lot since the last time I saw him. . . He has continued working but is only able to do that if he sees you fairly regularly. (from an April 4, 1995 letter to Dr. Ennis) (emphasis added).

[16] Dr. Williams monitored claimant for an extended period of time and we regard his observations concerning the benefits claimant received from past chiropractic care to be of considerable weight. From these observations, we specifically find that such care was reasonable and necessary treatment for claimant’s compensable injury for at least a time. We thus find respondents liable for chiropractic treatments rendered after the date of controversion and up until the date of this Opinion and Order, after which time claimant’s care is to be directed towards phasing out such treatments.

[17] Based on our de novo review of the entire record, and the reasons discussed hereinabove, we specifically find that claimant has failed to prove, by a preponderance of the credible evidence, that he is entitled to continued indefinite chiropractic care beyond that which is permitted by the terms of this Opinion and Order. However, we also specifically find that a preponderance of the evidence demonstrates that claimant is entitled to a six-month period of continued treatment, commencing upon the date this Opinion and Order is received by both parties, intended to phase out ongoing chiropractic manipulations and physical therapy modalities. Finally, we find that the evidence preponderates in favor of a finding that respondents are liable for chiropractic care rendered prior to the date of this Opinion and Order.

[18] The decision of the Administrative Law Judge should therefore be, and hereby is, affirmed in part and reversed in part.

[19] All accrued benefits shall be paid in a lump sum without discount and with interest thereon at the lawful rate from the date of the Administrative Law Judge’s decision in accordance with Ark. Code Ann. § 11-9-809 (Repl. 1996).

[20] For prevailing on this appeal before the Full Commission, claimant’s attorney is hereby awarded an additional attorney’s fee in the amount of $250.00 as provided by Ark. Code Ann. § 11-9-715 (b) (Repl. 1996).

[21] IT IS SO ORDERED.

DAVE GREENBAUM, Special Chairman PAT WEST HUMPHREY, Commissioner

[22] Commissioner Holcomb dissents.