Opinion
CLAIM NO. E515345
OPINION FILED MARCH 9, 1998
Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas.
Claimant represented by the HONORABLE F.S. "RICK" SPENCER, Attorney at Law, Mountain Home, Arkansas.
Respondents represented by the HONORABLE BETTY J. DEMORY, Attorney at Law, Little Rock, Arkansas.
Decision of Administrative Law Judge: Affirmed as modified.
OPINION AND ORDER
[2] The claimant appeals and the respondents cross-appeal an opinion and order filed by the administrative law judge on April 28, 1997. In that opinion and order the administrative law judge found that the claimant proved by a preponderance of the evidence that he sustained a compensable injury on February 3, 1995. The administrative law judge found the respondents liable for all "reasonable related medical expenses" incurred by the claimant, and the administrative law judge found that the claimant failed to prove by a preponderance of the evidence that he was entitled to any additional medical treatment.After conducting a de novo review of the entire record, we find that the claimant proved by a preponderance of the evidence that he sustained a compensable aggravation of a preexisting groin condition as the result of a specific incident at work which occurred on February 3, 1995. In addition, we find that the claimant proved by a preponderance of the evidence that he is entitled to reasonably necessary medical benefits associated with that aggravation. However, we also find that the claimant failed to prove that any medical treatment on or after April 3, 1996, was reasonably necessary for treatment of the claimant's compensable injury. Therefore, we find that the decision of the administrative law judge must be affirmed as modified.
Since the claimant contends that he sustained an injury after July 1, 1993, this claim is controlled by the Arkansas Workers' Compensation Law as amended by Act 796 of 1993. Consequently, to establish the compensability of the claim, the claimant must satisfy the requirement for establishing one of the five categories of compensable injuries recognized by the amended law, including the requirements common to all categories of injuries.See, Jerry D. Reed v. Con Agra Frozen Foods, Full Workers' Compensation Commission, opinion filed Feb. 2, 1995 (Claim No. E317744). Since the claimant in the present claim alleges that he 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) (Repl. 1996) 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) (Repl. 1996); Ark. Code Ann. § 11-9-102(5)(E)(i) (Repl. 1996); see also, Ark. Code Ann. § 11-9-401(a)(1) (Repl. 1996));
(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) (Repl. 1996));
(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) (Repl. 1996));
(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) (Repl. 1996)).
In the present case, we find that the preponderance of the evidence establishes that the claimant sustained a work-related aggravation to a preexisting groin injury as a result of a lifting incident that occurred on February 3, 1995, while the claimant was employed at Marshall Milling Co. In reaching that conclusion, we note that Randy Hubbard, the claimant's immediate supervisor and the son of James Hubbard, who owned Marshall Milling Co., testified that the claimant reported a work-related incident on that date. However, Randy Hubbard's testimony also suggests that some of the claimant's limping between February of 1995, and November of 1996, appeared to have been feigned or exaggerated. James Hubbard testified that, despite the claimant's having been off work for various short periods between February of 1995 and November of 1996, that the claimant received his full salary during this period.
The testimony of Tammy Hester, the respondent carrier's branch manager adjustor, indicates that although the respondent employer had knowledge of the alleged work-related injury, the respondent carrier was not made aware of any sort of work-related claim until notified by a Workers' Compensation Commission Report of Injury in October 1995. According to Ms. Hester, the respondent carrier did not refer the claimant to any medical physician until contacted by a legal advisor at the Workers' Compensation Commission requesting an evaluation to determine whether or not there were any objective findings to support the claimant's claim for benefits. The respondent carrier subsequently referred the claimant to Dr. Safman and Dr. Helming in October and November of 1996 (approximately twenty months after the alleged work-related injury and five months prior to the hearing in this case) for an evaluation for the claimant's persistent complaints. It appears that all of the treatment that the claimant received prior to October of 1996, was initiated by the claimant.
With regard to the medical treatment which the claimant initiated prior to the assessments of Dr. Helming and Dr. Safman, the medical record indicates that the claimant first presented to the Marshall Family Practice Rural Health Clinic on February 4, 1995, the day after the alleged work-related injury. Significantly, that report indicates the claimant was experiencing pain in his left hip through his groin, "that the groin has been painful all year", and that the claimant had been experiencing back problems for approximately two weeks. That report indicates a diagnosis of lumbar sacral strain and potential "chronic groin strain". However, none of the medical records in the evidence contained any objective diagnostic or medical observations to support any objective finding to the claimant's lumbar spine. Therefore, we find that the claimant has failed to prove by a preponderance of the evidence that he sustained a compensable injury to the lumbar spine.
However, to the extent that the respondents assert that the claimant failed to establish a groin injury by objective findings, we also note that the next report from Marshall Family Practice dated February 6, 1995, indicates a "mass" noted in the left inguinal area with tenderness to palpation and an indication from the claimant that he was experiencing pain that was unbearable. We find that the medical observation of a mass noted in the left inguinal area on February 6, 1995, three days after the lifting incident, establishes the claimant's work-related groin injury by objective medical findings. Compare, Daniel v. Firestone Building Products, 57 Ark. App. 123, ___ S.W.2d ___ (1997). The medical record indicates that the claimant was followed for groin complaints on February 15, 1995, April 26, 1995, April 27, 1995, and November 17, 1995. The claimant was restricted to light-duty lifting on February 7, 1995, and on February 15, 1995. An April 26, 1995, report indicates that the claimant was seen at Marshall Milling Co. and reported that he was well and back to loading feed, etc. The April 27, 1995, note indicates that the claimant was called to pick up a Workers' Compensation First Report of Injury form. The November 17, 1995, follow-up, approximately seven months later, indicates that the claimant was still reporting a problem in his groin with some swelling, and that the left groin area was extremely tender to touch and soft to palpation. At that time, the claimant was referred to Dr. Tom Bell by the Marshall Family Practice to rule out a hernia versus a groin strain.
The November 20, 1995, office note from Dr. Bell, a general vascular and thoracic surgeon, indicates that an examination revealed no evidence of a hernia and that the claimant probably had a chronic groin strain. According to that note, Dr. Bell prescribed Ibuprofen and instructed the claimant to see Dr. Daniel again in one month, and if the claimant's symptoms were not improved at that time that he would re-check for any evidence of a hernia.
The medical record indicates that the claimant did not return to Dr. Daniel until April 3, 1996, five months later. At that time, the claimant reported extreme sensitivity to palpation onboth sides of the inguinal area (i.e. bilaterally). As regards the claimant's diagnosis at that time, Dr. Daniel's April 3, 1996, report states "LT inguinal pain, etiology?"
The claimant returned to the Marshall Family Practice (Dr. Daniel) on August 6, 1996, August 20, 1996, November 7, 1996, and November 25, 1996, and reported discomfort and pain in the left inguinal area.
Dr. Helming, a urologist, examined the claimant on October 9, 1996, at the request of the respondent carrier. He determined that the claimant had no evidence of hernia or testicular problems and injected the claimant's left groin area with cortisone and xylocane based on the claimant's complaints of tenderness deep in the left groin area near the attachments of the ligaments to the bone. On follow-up on October 23, 1996, Dr. Helming indicated that he felt that the claimant's problem was not urologic but orthopedic in nature and suggested that the claimant consult an orthopedist and might benefit from some deep heat therapy or ultrasound therapy.
The respondents next referred the claimant to Dr. Bruce Safman, a physical medicine and rehabilitation specialist, on November 4, 1996. Dr. Safman indicated that it would be unusual for a patient to experience the tenderness that the claimant has had along the adductor tendons (left groin) for a year and a half. He suspected significant symptom magnification on the part of the patient. Dr. Safman indicated that a patient with adductor tendinitis could perform much more vigorous activities than those recorded by the claimant, which consisted of nothing more than lifting the weight of a newspaper at home. Dr. Safman suggested an exploration of emotional factors and other factors that may enhance symptom magnification.
For potential treatment of the claimant's persistent complaints, Dr. Safman suggested a possible re-injection of the adductor tendons or possibly a two week course of physical therapy with ultrasound and hot packs to the area. However, Dr. Safman indicated that if this treatment would not resolve the claimant's symptoms, he would discontinue follow-up care. In addition, Dr. Safman indicated there was no objective reason to restrict the claimant's job responsibilities.
We note that no physician has ever proposed placing the claimant on light-duty work or to remove or placing the claimant on off-work status after the restrictions placed on the claimant in February of 1995, and the greater weight of the evidence in the record indicates that the claimant has engaged in symptomatic magnification based on the observations of Randy Hubbard, the November 4, 1996, report of Dr. Safman, the testimony of James Hubbard, and on the April 3, 1996, report of Dr. Daniel who states that the claimant was reporting extreme sensitivity to palpation on both the left and right inguinal region at that time.
In light of the claimant's report of a painful groin which preexisted the lifting incident on February 3, 1995, but acute symptoms in the left inguinal area following the February 3, 1995, incident, as corroborated by co-workers, medical reports, and a medical observation of a "mass" in the claimant's left inguinal area on February 6, 1995, we find that the claimant proved by a preponderance of the evidence that he sustained an aggravation to a preexisting groin condition as a result of the lifting incident at work on February 3, 1995. We also find that the claimant proved by a preponderance of the evidence in the record that the medical services that he received at Marshall Family Practice between February and November of 1995, and the referral to Dr. Bell in November of 1995 were reasonably necessary for diagnosis and treatment of the work-related aggravation in the left inguinal area.
However, we also find that the preponderance of the evidence establishes that the work-related aggravation was temporary and resolved prior to the claimant's office visit to Dr. Daniel on April 3, 1996, approximately five months later. In reaching that decision, we note that on April 3, 1996, the claimant was complaining of extreme sensitivity on both sides of the inguinal region (no longer the left only), and Dr. Daniel's report indicates that he was no longer able to identify an etiology for the claimant's left inguinal pain complaints. Likewise, we note that neither Dr. Bell, Dr. Helming, or Dr. Safman were able to establish a medical basis for the claimant's ongoing complaints with clinical examinations and various treatment. On this record, we find that the claimant failed to prove by a preponderance of the evidence that the medical treatment that he initiated on or after April 3, 1996, was reasonably necessary for treatment of the injury that he sustained on April 3, 1995.
Therefore after conducting a de novo review of the entire record, and for the reasons discussed herein, we find that the decision of the administrative law judge must be, and hereby is, affirmed as modified.
For prevailing in part on this appeal before the Full Commission, claimant's attorney is hereby awarded an additional attorney's fee in the amount of $250.00 in accordance with Ark. Code Ann. § 11-9-715 (Repl. 1996).
IT IS SO ORDERED.
Commissioner Humphrey concurs. Commissioner Wilson dissents.