FIELDS v. LINCOLN MANUFACTURING

An Administrative Law Judge entered an opinion and order in the above-captioned claim on December 9, 1996, finding that medical treatment claimant had received to date (excepting chiropractic treatment, which was reserved) was reasonably necessary for the care of his compensable injury of May 31, 1994, and that he was entitled to a follow-up visit to Dr. Rebecca Barrett-Tuck but not to additional diagnostic studies.

Respondents now appeal from that opinion and order, contending that there was no objective basis to justify the treatment in question; and that Ark. Code Ann. § 11-9-509(1) (Repl. 1996) operates to bar additional medical treatment in this claim.

Following our de novo review of the entire record, we specifically find that the medical treatment claimant has received to date for his compensable injury of May 31, 1994, was reasonably necessary, and that he is further entitled to a follow-up consultation with Dr. Barrett-Tuck. The decision of the Administrative Law Judge is therefore affirmed.

The parties stipulated that claimant sustained an injury arising out of and in the course of his employment on May 31, 1994, when he slipped and fell "flat on [his] back." When claimant found it necessary to seek medical attention, respondents directed him to a Dr. Ragland, who performed a one-time examination on June 15, 1994. Dr. Ragland diagnosed a "lumbar contusion," and noted that x-rays revealed "definite osteoarthritic signs at several levels in the lumbar vertebrae." Though claimant was not taken off work and his back pain was expected to "resolve nicely," Dr. Ragland left open the possibility that if it did not, claimant "may need to consider bone scan and CT scan, etc."

Unfortunately, claimant's pain did not "resolve nicely." Instead, claimant continued to experience pain "in my pelvic area. I was, it was just, it was kind of like numb, and it was radiating down my right leg." Following a course of chiropractic treatment (a reserved issue not a part of this claim), claimant requested additional medical care owing to persistent back pain and numbness in his leg when working or walking. However, he was informed by Ms. Kathy Pace, respondent employer's human resources director, that the workers' compensation carrier would provide no additional coverage.

Nevertheless, claimant did seek treatment from a local Mediquik clinic, which in turn referred him to Dr. Rebecca Barrett-Tuck, a Jonesboro neurosurgeon. Dr. Barrett-Tuck examined claimant on February 7, 1995, and recorded the presence of "marked flattening of the lordotic curve and severe bilateral paraspinous muscle spasm to palpation." In addition, Dr. Barrett-Tuck noted from claimant's CT scan that he possessed a "mild disk bulge at L4-5 but no definite neural compromise. There is a disk protrusion at L5-S1, possibly affecting the S1 nerve root." Dr. Barrett-Tuck's ultimate assessment was that claimant suffered from "severe recurrent muscle spasms in the lumbar region in association with disk abnormality at L5-S1 and L4-5." Additional diagnostics, in the form of a lumbar myelogram and post-myelogram CT scan, were performed on February 9, 1995, at Dr. Barrett-Tuck's request. They produced essentially normal findings.

Dr. Barrett-Tuck thereafter placed claimant in an eight-week physical therapy program during which time he did not work. Claimant described the results of this treatment as "very" beneficial, and he returned to work in mid-March, 1995. He has worked continuously since that time, and explained at the hearing that he only experiences a "light numbness occasionally when I work over a, you know, hard over a period of time." When asked if this numbness emanated from the same general area that had troubled him since the May, 1994, injury, claimant answered in the affirmative. Claimant went on to state that he would like a return visit to Dr. Barrett-Tuck to find out "what her opinion is. Just ask for an opinion on what she thinks."

In the event of a work-related injury, it is the duty of respondent-employer to provide medical services that are "reasonably necessary in connection with the injury received by the employee." See Ark. Code Ann. § 11-9-508(a) (Repl. 1996). In assessing whether a given medical procedure is reasonably necessary for the treatment of a compensable injury, the Commission analyzes both the proposed procedure and the condition it is sought to remedy. Deborah Jones v. Seba, Inc., Full Workers' Compensation Commission, Opinion Filed December 12, 1989 (Claim No. D511255). While the results obtained may be a consideration in some cases, the primary considerations are the nature of the service in relation to the injury of the claimant. Tonnie Crisp v. Weyerhauser Corp., Full Workers' Compensation Commission, Opinion Filed July 27, 1993 (Claim No. D812922).

With regard to respondents' assertion that there are no objective findings to justify the additional medical treatment claimant received, we would point out that Act 796 only requires the presence of objective findings for matters relating to initial compensability and permanent anatomical impairment (See Ark. Code Ann. §§ 11-9-102(16)(A)(i) and 11-9-704(c)(1)(B) (Repl. 1996)). In addition, this Commission has previously held that the presence or absence of objective findings, though a factor, is not determinative when the duration of a given healing period is at issue. Larry Graham v. Chamber Door Indus., Inc., Full Workers' Compensation Commission, Opinion Filed January 9, 1997 (Claim No. E400258). By analogy, the same holds true for considerations of whether given medical treatment is reasonably necessary.

Even so, we would also point out that the record before us is hardly devoid of objective findings. As late as February 9, 1995, when claimant sought Dr. Barrett-Tuck's assistance, the latter noted the presence of flattening of the lordotic (lumbar) curve and "severe" bilateral muscle spasms in claimant's back. Muscle spasms are recognized as objective findings indicating the presence of a soft tissue injury. See Donna Lee Norvell v. J-Mar Express, Inc., Full Workers' Compensation Commission, Opinion Filed May 26, 1996 (Claim No. E402198). Accordingly, we are persuaded to find that claimant's continued lumbar difficulties, subsequent to his consultation with Dr. Ragland, are supported by an objective medical basis.

We find from claimant's credible testimony regarding his persistent lumbar difficulties, as well as Dr. Barrett-Tuck's findings of February 9, 1995, that the additional medical care claimant obtained from the Mediquik clinic and Dr. Barrett-Tuck was reasonably necessary for the diagnosis and care of his May 31, 1994, compensable injury. Likewise, in light of Dr. Barrett-Tuck's discovery of severe muscle spasms and possible disk abnormalities, we find that the additional diagnostics performed upon her recommendation were reasonably necessary in order to evaluate the extent of claimant's injury. In reaching this particular conclusion, we have also relied on the report of Dr. Ragland, claimant's initial treating physician, who opined as early as June, 1994, that additional diagnostic efforts would be indicated if claimant's symptoms did not improve.

While the additional diagnostics ordered by Dr. Barrett-Tuck produced relatively normal findings, the degree of muscle spasm and flattening of the lordotic curve she originally noted suggests that claimant suffered from at least a continuing soft tissue injury. We accordingly find that the additional conservative treatment recommended by Dr. Barrett-Tuck, in the form of physical therapy, was reasonably necessary for the treatment of such an injury.

We would also point out claimant's credible testimony which establishes that he enjoyed significant benefits from that treatment, and that it has apparently enabled him to return to work with no measurable limitation.

While claimant has thus completed the course of physical therapy recommended by Dr. Barrett-Tuck and obtained good results therefrom, prudence dictates that he should not be left without at least some degree of follow-up care. We specifically find that a return visit to Barrett-Tuck for an assessment of claimant's current condition is appropriate and reasonably necessary under the circumstances of this case.

Based on the foregoing, we specifically find that claimant has proven, by a preponderance of the credible evidence, that the medical care he has received to date for the effects of his May 31, 1994, compensable injury, was reasonably necessary; and that he is entitled to an additional follow-up consultation with Dr. Barrett-Tuck.

Ark. Code Ann. §§ 11-9-509 and 11-9-509(1) (Repl. 1996) provide that:

The amounts payable or time periods allowable for authorized medical, hospital, and other services and treatment furnished under §§ 11-9-508 — 11-9-516, unless waived by the employer-respondent or approved by the commission and warranted by the preponderance of the evidence on the basis of the record as a whole, are:

(1) Six (6) months if the claimant lost no compensable time from work as a result of his injury;

Because we have found that claimant's medical treatment subsequent to his consultation with Dr. Ragland was reasonably necessary, and thus warranted, according to a preponderance of the evidence on the basis of the record as a whole, we specifically find that Ark. Code Ann. § 11-9-509 (Repl. 1996) does not operate to bar this claim.

Following our de novo review of the entire record, and for the reasons discussed herein, we specifically find that claimant has proven, by a preponderance of the credible evidence, that the medical treatment he has received to date for the effects of his May 31, 1994, compensable injury was reasonably necessary; and that he is entitled to an additional follow-up consultation with Dr. Barrett-Tuck. We further specifically find that Ark. Code Ann. § 11-9-509 (Repl. 1996) does not operate to bar this claim. The decision of the Administrative Law Judge must therefore be, and hereby is, affirmed.

All accrued benefits shall be awarded 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).

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 pursuant to Ark. Code Ann. § 11-9-715(b) (Repl. 1996).

IT IS SO ORDERED.