Opinion
CLAIM NO. E413910
OPINION FILED MARCH 11, 1996
Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas.
Claimant appears pro se.
Respondents represented by the HONORABLE JAMES A. ARNOLD, II, Attorney at Law, Fort Smith, Arkansas.
Decision of Administrative Law Judge: Affirmed.
OPINION AND ORDER
The claimant and the respondents appeal an opinion and order filed by the administrative law judge on September 13, 1995. In that opinion and order, the administrative law judge found that the claimant failed to prove by a preponderance of the evidence that she sustained a compensable injury to her left knee on July 12, 1994. In addition, the administrative law judge found that the Statute of Limitations does not bar the claimant's claim for additional medical treatment for a right knee injury sustained in 1989.
After conducting a de novo review of the entire record, we find that the claimant failed to prove by a preponderance of the evidence that she sustained a compensable injury to the left knee. In addition, we find that the respondents failed to prove by a preponderance of the evidence that the Statute of Limitations bars the claim for additional medical treatment for the claimant's right knee. Therefore, we find that the administrative law judge's decision must be affirmed.
The claimant sustained an admittedly compensable injury to the right knee in May of 1989 while employed by the respondent. She came under the care of Dr. Don Bailey, an orthopedic surgeon, who performed arthroscopic surgery on the right knee in August of 1989. Shortly thereafter, the claimant came under the care of Dr. Tom Coker, who prescribed follow-up conservative care. Dr. Coker released the claimant to normal duties on November 16, 1989, and advised her that she should return as needed.
The claimant continued to experience residual knee symptoms, however, and she returned to Dr. Coker from time to time for this and other work-related injuries. Dr. Coker performed a second arthroscopy and a lateral release procedure in January of 1992, and released the claimant to return to work on February 24, 1992. The claimant returned to Dr. Coker for follow-up care at routine intervals during 1992, and Dr. Coker indicated that the claimant could return for care on an as needed basis after December 31, 1992. The claimant returned on June 1, 1993, and at that time reported that the right knee felt "pulled" or "locked" on an increasingly frequent basis. After an essentially normal clinical examination, Dr. Coker instructed the claimant to try relaxing the knee and moving the patella with her fingers when she felt the locking sensation.
The claimant testified that she was involved in a work-related accident on December 8, 1993, when a pallet fell, striking her on the right calf. The claimant received her first medical attention after the accident from Dr. David Ewart on December 14, 1993 and December 30, 1993. Dr. Ewart apparently placed the claimant off work for one day, to return to work without restrictions on December 16, 1993.
On January 12, 1994, Dr. Terry Sites, an orthopedic specialist, examined the claimant. At that time, the claimant reported pain and swelling in her right knee, right leg and right ankle which she indicated began shortly after the work-related incident on December 8, 1993. Dr. Sites performed an evaluation of the claimant's knee, including range of motion tests and x-rays. In that regard, Dr. Sites reported that the right knee range of motion was normal, and that the right knee appeared stable when compared to the left. He also reported that x-rays of the claimant's knees indicated mild degenerative changes, including patellofemoral joint space narrowing, peripheral osteophytes, and some osteopenia. Dr. Sites prescribed a regimen of exercises and cycling, as well as a two week instruction in a home program in order to strengthen the claimant's right knee.
On January 13, 1994, the claimant returned to Dr. Coker. Dr. Coker reported "some increased difficulty with her patella which would be due secondary to the weakness following the injury" of December 8, 1993. Dr. Coker observed that the claimant's right patella had done well until the work-related incident in December of 1993, and opined that he expected the patella to do well again for the foreseeable future.
On February 23, 1994, the claimant returned to Dr. Sites, reporting occasional pain in the right knee and right ankle. Dr. Sites did not observe any effusion or swelling in the knee. However, Dr. Sites reported that the claimant's chronic problems with knee and ankle pain may have been aggravated by the recent trauma to the calf on December 8, 1993. Dr. Sites advised the claimant to return in three months if she continued to experience problems.
The claimant testified that she continued to experience pain and soreness in the right knee, and that she requested her employer's medical coordinator, Vicki Gill, to schedule another appointment with Dr. Coker for examination of her right knee. The claimant also testified that Ms. Gill delayed in scheduling the requested appointment, and that she experienced another work-related accident approximately two weeks after her request. In that regard, the claimant testified that, on July 13, 1994, she dropped a 50 pound box of staples which she contends resulted in an injury to her left knee when she caught the falling box. According to the claimant, she felt an instant reaction in the left knee.
Dr. Chokers records indicate that the claimant presented on July 14, 1994, with complaints concerning both knees. As regards the left knee, Dr. Coker determined that the ligaments were intact, and his report does not indicate any observed swelling or effusion. Results from x-rays taken of the left knee were normal, and Dr. Coker diagnosed a possible tear of the left medial tendon based on the claimant's description of her pain. As regards the right knee, Dr. Coker suggested an injection of corticosteroid to control the claimant's reported symptoms of pain and swelling, but the claimant declined the corticosteroid injection for her right knee. Dr. Cokers medical records indicate that the claimant returned on several occasions during July and August of 1994 for follow-up attention to her left knee, but she apparently did not receive any additional examination or treatment for the right knee after July 14, 1994.
The respondents contend that the claimant's request for additional medical treatment for the right knee is barred by the Statute of Limitations. In that regard, the respondents admit that they provided the claimant medical treatment for her right knee injury through June 1, 1993. However, the respondents contend that they did not provide the claimant any additional medical care or other compensation for the 1989 right knee injury after June 1, 1993. Therefore, according to the respondents, the claimant's claim for additional medical care for the right knee filed on May 5, 1995, is barred by the Statute of Limitations.
Because the claimant sustained her compensable right knee injury before July 1, 1993, her claim for additional medical compensation for that injury is subject to the Arkansas Workers' Compensation Law as it existed prior to the amendments of Act 796 of 1993. The Statute of Limitations for claims seeking additional compensation is set forth in Ark. Code Ann. § 11-9-704 (b) (1987). This subsection provides that claims for "additional compensation shall be barred unless filed with the commission within one (1) year from the date of the last payment of compensation or two (2) years from the date of the injury, whichever is greater." The furnishing of medical treatment constitutes compensation for the purposes of this statute. However, the furnishing of medical treatment constitutes compensation only if the treatment is reasonably necessary for the treatment of the compensable injury. Northwest Tire Service v. Evans, 295 Ark. 246, 748 S.W.2d 134 (1988). Moreover, it is the furnishing of medical treatment, not the actual payment for those services, which constitutes the payment of compensation for the purposes of this statute. Heflin v. Pepsi Cola Bottling Co., 195 Ark. 244, 424 S.W.2d 365 (1969); Cheshire v. Foam Molding, 37 Ark. App. 78, 822 S.W.2d 412 (1992). In this regard, the key is that the employer must furnish the medical treatment in order to toll the limitations period. See, McFall v. U.S. Tobacco Co., 246 Ark. 43, 434 S.W.2d 838 (1969).
In the present claim, the medical records indicate that the claimant has experienced persistent symptoms with her right knee injury since 1989, and the respondents admit providing the claimant medical treatment for the right knee injury through June 1, 1993. However, as discussed, the claimant's right knee was also examined and tested by Dr. Sites in January and February of 1994, and by Dr. Coker in January and July of 1994. The January and February doctor appointments were apparently scheduled primarily in response to the blow received to the claimant's right calf, and the July examination was apparently scheduled primarily in response to an alleged injury to the left knee. However, in each visit the right knee received some degree of examination, a diagnosis, and some proposal for treatment or follow-up examination. In addition, the respondents scheduled some, if not all, of the claimant's appointments with Dr. Sites and Dr. Coker through July 14, 1994, and a summary of each office visit was documented by a letter from the examining physician addressed to either the respondent employer or the respondent carrier. In addition, respondents paid for each office visit to both Dr. Sites and Dr. Coker through July 14, 1994. Thus, we find that the respondents furnished the claimant reasonably necessary medical treatment for her compensable right knee injury through July 14, 1994, which is less than one year prior to the date that the claimant filed her claim to request additional medical treatment for the right knee on May 5, 1995. Accordingly, we find that the respondents failed to prove by a preponderance of the evidence that the Statute of Limitations bars the claimant's request for additional reasonably necessary medical treatment for the right knee.
The claimant also contends that she sustained a compensable injury to the left knee on July 12, 1994, while catching a box of falling staples. Since the claimant contends that she sustained this alleged injury after July 1, 1993, her claim for benefits related to the left knee is controlled by the Arkansas Workers' Compensation Law as amended by Act 796 of 1993. Since the claimant alleges that she sustained an injury as a result of a specific incident which is identifiable by time and place of occurrence, the requirements of Ark. Code Ann. § 11-9-102 (5)(A)(i) (Cumm. Supp. 1995) are controlling, and the following requirements must be satisfied:
(1) proof by a preponderance of the evidence of an injury arising out of and in the course of his employment (see, Ark. Code Ann. § 11-9-102 (5)(A)(i) (Cumm. Supp. 1995); Ark. Code Ann. § 11-9-102 (5)(E)(i) (Cumm. Supp. 1995); see also, Ark. Code Ann. § 11-9-401 (a)(1) (Cumm. Supp. 1995));
(2) proof by a preponderance of the evidence that the injury caused internal or external physical harm to the body which required medical services or resulted in disability or death (see, Ark. Code Ann. § 11-9-102 (5) (A)(i) (Cumm. Supp. 1995));
(3) medical evidence supported by objective findings, as defined in Ark. Code Ann. § 11-9-102 (16), establishing the injury (see, Ark. Code Ann. § 11-9-102 (5)(D) (Cumm. Supp. 1995));
(4) proof by a preponderance of the evidence that the injury was caused by a specific incident and is identifiable by time and place of occurrence (see, Ark. Code Ann. § 11-9-102 (5)(A)(i) (Cumm. Supp. 1995)).
If the claimant fails to establish by a preponderance of the evidence any of the requirements for establishing the compensability of the injury alleged, she fails to establish the compensability of the claim, and compensation must be denied.Jerry D. Reed v. Con Agra Frozen Foods, Full Workers' Compensation Commission, Feb. 2, 1995 (Claim No. E317744).
In the present claim, we find that the claimant failed to establish a compensable injury to the left knee with medical evidence supported by objective findings. Objective findings are defined in Ark. Code Ann. § 11-9-102 (16) (Cumm. Supp. 1995) as "those findings which cannot come under the voluntary control of the patient." As discussed, the results of Dr. Coker's x-ray of the left knee performed on July 14, 1994, were normal, and Dr. Coker did not report any effusion or swelling in the left knee on examination that date. Likewise, Dr. Coker's medical reports do not indicate that he observed any swelling or effusion during any of his clinical examinations of the left knee on July 26, 1994, and on September 21, 1994.
Accordingly, after a de novo review of the entire record, and for the reasons discussed herein, we find that the respondents failed to prove that the Statute of Limitations bars the claimant's claim for additional medical treatment for her 1989 right knee injury. However, we also find that the claimant failed to prove by a preponderance of the evidence that she sustained a compensable injury to the left knee. Therefore, we find that the administrative law judge's decision must be, and hereby is, affirmed.
IT IS SO ORDERED.
Commissioner Humphrey concurs.