JONES v. RAILROAD CONTRACTING

OPINION AND ORDER

The respondents appeal an opinion and order filed by the administrative law judge on October 9, 1997, finding that the claimant proved by a preponderance of the evidence that he sustained an ulnar neuropathy and reflex sympathetic dystrophy that are causally related to a work-related incident that occurred on December 21, 1995, that the claimant remained within his healing period and remained incapacitated to earn from December 21, 1995 until March 24, 1997, and that the claimant proved by a preponderance of the evidence he sustained a 10% permanent impairment rated to the upper extremity as a result of the incident on December 21, 1995.

After conducting a de novo review of the entire record, we find that the decision of the administrative law judge must be reversed. Specifically, we find that the greater weight of the credible evidence establishes that the claimant's elbow fracture sustained on December 21, 1995, resolved prior to the respondents' termination of temporary disability compensation. We further find that claimant has failed to prove entitlement to a physical impairment rating. Therefore, we find that the respondents are entitled to a credit for a 10% anatomical rating to the upper extremity paid by the respondents based on a forged medical document purportedly signed by Dr. Michael Moore and purportedly assigning the claimant a 10% impairment rating on June 17, 1996. In addition, we find that the claimant has failed to establish by a preponderance of the credible evidence that his alleged ulnar neuropathy or his alleged reflex sympathetic dystrophy condition, for which he sought additional treatment in approximately October of 1996, are causally related to the incident that occurred on December 21, 1995. Consequently, we find that the claimant has failed to prove that he is entitled to the additional temporary disability compensation and medical benefits at issue in this case. Finally, we are referring this claim to the Arkansas Workers' Compensation Fraud Unit for investigation of the various forged documents and alleged fraudulent conduct documented in the record. Because we find that the claimant failed to prove that he is entitled to any of the benefits at issue in this case, we do not reach the respondents' alternative arguments for denying any additional liability in this case.

I. BACKGROUND.

A background discussion will be beneficial since the claimant has sustained several injuries while employed by various employers and since the record contains falsified documents and inaccurate medical histories.

1. Injuries

The record reflects the claimant has sustained at least three alleged work-related injuries since 1990. The claimant sustained a work-related back injury on April 5, 1990 while employed by Tyson. The claimant was treated by Dr. Armstrong for that injury and subsequent flare-ups. Several reports from Dr. Armstrong in the record question symptom magnification based on observations by Tyson workers and by Dr. Armstrong's own staff. In a note dated May 27, 1992, Dr. Armstrong also suggested that the claimant had changed a return to work date on a return to work slip.

The claimant also sustained an injury to his right upper extremity while working for Camden Wire. According to the claimant's testimony, this injury occurred in 1993 or 1994 (prior to his employment with the respondents herein) when a door closed which "busted two of my fingers, scarred up my hand, and pulled my arm." The medical record contains a report indicating that the claimant was followed for this injury by Dr. Michael Moore. Dr. Moore's June 13, 1994 report indicates that the claimant experienced a right ulnar nerve submuscular transposition. According to this report, a nerve conduction and EMG study were performed which did not suggest significant compression of the ulnar nerve. This report goes on to state that the claimant was treated with multiple treatment modalities including medication and intensive therapy; however, the claimant did not respond to these treatments and reported persistent symptoms including complaints of pain in the right arm, as well as weakness of grip and pinch strength. Dr. Moore indicated that the claimant had undergone a previous validity testing which revealed a submaximal effort. As a result of this injury, Dr. Moore assigned the claimant a 10% anatomical impairment rating to the right arm based on decreased range of motion, grip strength, and repeat nerve conduction testing which did not suggest significant compression of the claimant's ulnar nerve. Although not specifically indicated in Dr. Moore's June 13, 1994, report, a subsequent 1996 report from Dr. Moore indicates that the claimant underwent a right cubital tunnel release and medial epicondylectomy surgery on November 16, 1993, to treat the 1993 injury.

With regard to the injury which is the subject of this claim, the claimant testified that he sustained an injury to his right arm on December 21, 1995, when he was struck in the elbow by a co-worker with a sledge hammer. Following this incident, the claimant was initially treated by Dr. Charles Clark, an orthopedic specialist in Pine Bluff, who diagnosed the claimant with a nondisplaced medial epicondylar fracture which required a cast. Dr. Clark's January 31, 1996, note indicates that the claimant's medial epicondylar fracture had healed in good position, but that the claimant was reporting persistent symptoms in the ulnar nerve above the ulnar groove. Dr. Clark indicated that the claimant's symptoms appeared to be within the ulnar nerve distribution of numbness and tingling extending down to his fourth and fifth fingers, but that motor function appeared to be intact and normal. Dr. Clark assessed a neurapraxia secondary to the claimant's contusion. Dr. Clark ordered nerve conduction studies which were performed on January 8, 1996.

In his February 28, 1996, office note, Dr. Clark indicated that the nerve conduction studies showed a generalized ulnar neuropathy consistent with neurapraxia, and that, other than specific localized entrapment, the medial malleolar fracture did recover very well with respect to motion and healing on radiographs. Dr. Clark recommended therapy and strengthening and indicated that he did not believe the claimant was a candidate for operative intervention. On March 15, 1996, Dr. Clark again indicated that he did not believe operative intervention would be helpful with a generalized neuropathy, and Dr. Clark indicated that he would start the claimant in a work hardening program for strengthening and increasing range of motion of the claimant's right arm and elbow, with follow-up in three weeks. Dr. Clark indicated that if the claimant was not significantly improved at that time he would recommend a second opinion from the claimant's previous surgeon, Dr. Moore. When the claimant's complaints persisted, Dr. Clark referred the claimant to Dr. Moore for a second opinion.

After evaluating the claimant on May 13, 1996, Dr. Moore opined that the claimant's physical examination indicated mild irritation of the ulnar nerve at the cubital tunnel similar to the symptoms that the claimant had complained of at the time of his discharge, from his previous injury on June 13, 1994. Dr. Moore advised that the claimant should begin a home therapy program including range of motion and strengthening exercises and a short course of iontophoresis. In addition, Dr. Moore requested that the claimant undergo repeat nerve conduction and EMG studies of his right arm and indicated that, if the study did not reveal any evidence of a progressive or recurrent cubital tunnel syndrome, that the claimant would not require any long term treatment or therapy.

There are two letters purportedly under the signature of Dr. Michael Moore in the record dated June 17, 1996. As discussed below, the evidence indicates that one of these letters was in fact prepared by Dr. Moore, and the other letter was a forgery faxed to the respondent on October 15, 1996.

The valid letter from Dr. Moore dated June 17, 1996, indicates that the claimant's most recent nerve conduction and EMG study suggested an abnormality of the ulnar nerve; however, the valid letter indicates that Dr. Moore's physical examination did not reveal significant deterioration of the claimant's ulnar nerve function. Dr. Moore went on to report that the claimant was recently seen by Dr. Reginald Rutherford, a neurologist at the Pain Center, and that Dr. Rutherford opined that the claimant did not require surgical treatment. Dr. Moore's valid June 17, 1996 report indicates that Dr. Rutherford agreed with Dr. Moore's opinion that the claimant's physical examination did not suggest further deterioration of the ulnar nerve function, examination did not reveal any evidence of muscle weakness, and that the claimant's sensory examination revealed purported diminished sensation throughout his hand, but not specific to the ulnar nerve. In addition, Dr. Moore noted that the sensory examination was a subjective test, and Dr. Moore indicated that the claimant underwent a BT validity test on June 17, 1996 which revealed a submaximal effort. Dr. Moore's valid June 17, 1996, letter goes on to conclude:

It is my opinion Mr. Jones does not have significant evidence of recurrent cubital tunnel syndrome. It is my opinion he should wear an elbow pad and splint as needed.

In a subsequent letter dated July 10, 1996, Dr. Moore indicated that the claimant's impairment rating had not changed since 1994.

The claimant returned to Dr. Moore's office approximately three months later, on October 16, 1996, with complaints of pain over the medial aspect of his elbow, and numbness in the ring and small fingers of his right hand. Dr. Moore again reiterated that he did not feel the claimant was a candidate for surgical treatment, and Dr. Moore recommended the claimant return to Dr. Rutherford for follow-up evaluation. Dr. Moore indicated that Dr. Rutherford might elect to repeat nerve conduction and EMG studies and might wish for the claimant to see Dr. Winston Wilson for psychological evaluation. Dr. Moore indicated that he would defer to Dr. Rutherford's opinion regarding this matter.

Approximately four weeks after the claimant was last seen by Dr. Moore on October 16, 1996, the claimant presented to Jefferson Regional Medical Center, where he was followed by Dr. Charles Watson. Notably, Dr. Watson's history taken from the claimant is inaccurate, indicating that the claimant's initial injury occurred on December 21, 1995, and indicating that the claimant was operated on by Dr. Moore approximately one month after that injury. The history that the claimant provided Dr. Watson is clearly contrary to Dr. Moore's reports indicating that Dr. Moore did not begin to see the claimant after the 1995 injury until May of 1996, and also indicating that the only surgery he ever performed on the claimant was in November of 1993, prior to the claimant's employment with the respondent.

Dr. Watson's first examination indicated that the claimant was experiencing purported limited range of motion in hisshoulder, parascapular tenderness around the right scapula, trigger points superior and medial to the top of the scapula. However, Dr. Watson also indicated that the claimant was experiencing a full range of motion in his elbow and in his wrist. Dr. Watson went on to report the claimant could not pronate or supinate fully, that the claimant could not fully extend his fingers, that the claimant's palms were dry, that the claimant's right arm had more hair than his left arm, and that the claimant's right arm felt warmer than his left hand. Dr. Watson diagnosed the claimant with reflex sympathetic dystrophy of the right upper extremity and myofacial pain in the right parascapular area. As a result of this diagnosis, Dr. Watson subsequently performed a series of stellate ganglion blocks. Dr. Watson also began the claimant on another round of physical therapy which the claimant apparently terminated with Dr. Watson's agreement on or about February 10, 1997.

Dr. Watson testified that he chose to stop treating the claimant when it was clear that the claimant was not getting significantly better over time. Dr. Watson also noted that a major discrepancy that he observed was in the claimant's residual functional capacity evaluation. According to Dr. Watson, that test could not be accurately interpreted because the claimant gave sub-optimal effort. Dr. Watson testified that the last time he saw the claimant was on March 24, 1997, and that he advised the claimant that in his opinion, the claimant should pursue vocational rehabilitation.

Dr. Watson testified he was not asked to assign claimant an impairment rating so he did not assess one. He further testified:

Q. Okay. So as far as taking a look at Dr. Clark's March 10th, 1997 impairment rating, have you analyzed his impairment rating?

A. Not yet.

Q. Okay. So you haven't sat down in your office with the AMA GUIDES TO THE EVALUATION OF PERMANENT IMPAIRMENT, 4TH EDITION Impairment Guidelines and verified independently whether you agree with the accuracy of that impairment rating; is that fair to say?

A. No, I haven't.

Q. Okay. So you have no reason to either agree or disagree with the accuracy of that rating; is that fair to say, Doctor?

A. That's right.

Notably, after Dr. Clark's April 8th, 1996 report referring the claimant to Dr. Moore, the next medical report in the record from Dr. Clark is a January 15, 1997 report, approximately nine months later. According to the January 15, 1997 report, the claimant was still purportedly tender over the medial epicondyle, and he was tender with a Tinel's over the elbow. Dr. Clark also indicated a 15x lack of extension (presumably in the elbow), but indicated that the claimant was able to extend his digits to make a fist. Dr. Clark went on to indicate that if the claimant was experiencing a significant cubital tunnel-type symptomology, Dr. Clark would recommend a re-exploration of the ulnar nerve at the claimant's elbow.

In a January 24, 1997, office visit following repeat nerve conduction studies, Dr. Clark indicated that the repeat nerve conduction studies were consistent with a generalized ulnar neuropathy which is not surgically treatable, and that it would be best treated either by a neurologist or a chronic pain clinic. Dr. Clark indicated that he was referring the claimant to Dr. Charles Watson at the Chronic Pain Clinic for evaluation and treatment, and indicated that he (Dr. Clark) had no further treatment to offer the claimant and was releasing the claimant from his care.

The only other report from Dr. Clark is a March 10, 1997, report indicating that the claimant was in the office for follow-up of reflex sympathetic dystrophy of the right arm, following a medial epicondylar avulsion fracture and ulnar nerve involvement. According to that report, the claimant underwent an ulnar nerve transposition (apparently referring to Dr. Moore's 1994 surgery) which corrected the cubital tunnel symptomology for a while, and then he developed rather marked reflex sympathetic dystrophy. Dr. Clark noted that the claimant was undergoing intensive therapy with Dr. Charles Watson for reflex sympathetic dystrophy, that the blocks initially worked quite well, but that the claimant was presently having refraction to the treatment. Dr. Clark indicated that the claimant had sustained a 0% permanent partial impairment rating for the epicondylar fracture for which he initially treated the claimant. However, Dr. Clark also indicated with respect to a permanent anatomical impairment rating that:

The reflex sympathetic dystrophy following the epicondylar fx has left him with significant deficits of the R upper extremity. He has associated loss of flexion and extension of all digits, to where he is limited to about a 60x arc of motion at the MP joints, about a 30x motion at the PIP joints, and very minimal motion at the DIP joints. He holds the arm internally rotated at his side and will not actively abduct, forward flex or extend, or internally/externally rotate the shoulder unless prompted. Passively I can put it through a full ROM, but actively he will move it very little and the measurements are inconsistent. Most of the lack of motion, I think, is due to discomfort. I would categorize this as a significant peripheral nerve impairment with marked degradation of strength. This pain and persistent peripheral nerve disorder does significantly interfere with his performance of daily activities. I think the primary nerve involved is the ulnar, median and radial nerves of the forearm. I think he has loss of both motor and sensory function in the ulnar and median nerves. I would grade this, according to Table 11, Chapter 3, Page 48 of the AMA Guides to the Evaluation of Permanent Impairment, as a Grade IB Sensory Deficit or pain that has decreased sensibility with or without abnormal sensation, pain which may prevent activity, and/or minor causalgia. The percent sensory deficit associated with this would be APPROXIMATELY 75%. Similarly, according to Table 12, his motor deficit would be classified as Grade III with active movement against gravity only, without resistance, rated at 30% for motor function deficit. I would grade the overall deficit in the R upper extremity at 70% at this time. I think that this is a permanent problem and it is doubtful that it will respond to ongoing therapy. The conversion factor, according to Table III, Chapter 3, Page 20 for upper extremity involvement of 75%, would be 45% impairment of the whole person.

2. Fraudulent Documents

The record contains three medical reports which the respondent carrier determined at some point in 1996 and 1997 were falsified.

a. 10% Impairment Rating

The first relevant medical record which the respondents have determined to have been falsified in this case is a letter dated June 17, 1996, which purports to be under the signature of Dr. Michael Moore and is addressed to Acordia. This letter has a fax identification at the top of each page indicating that the document was faxed from Harvest Foods store number 241 on October 15, 1996 at 2:46 p.m. With regard to this document, Ms. Kami Ross a former adjustor for Acordia, testified that she was assigned to the claimant's case and that she had various conversations and received various documents from the claimant over a period of time. Ms. Ross testified that, according to her notes, she had telephone conversations with the claimant on October 14, 1996, and October 15, 1996, and Ms. Ross verified that she received the document in question on October 15, 1996, consistent with the date stamp on the document.

A June 5, 1997, letter signed by Dr. Michael Moore addressed to the respondent's attorney states that a document purportedly dated June 17, 1996, containing a 10% anatomical impairment rating, appears to have been falsified. Dr. Moore explained: (1) the office letterhead was changed to reflect his new company in March of 1995, (2) his previous transcriptionist whose initials appear on the document terminated her employment with his office on March 31, 1995, and was not employed by Dr. Moore on June 17, 1996, (3) the present transcriptionist was hired on March 18, 1996 and her initials did not appear on the June 17, 1996, document, (4) Dr. Moore's office chart did not contain the June 17, 1996 letter in question purporting to assign a 10% anatomical impairment rating and, (5) according to Dr. Moore no one in his office was given permission to alter any of the documents in the claimant's charts.

b. Mileage Reimbursement

The record contains two forms purportedly under the signature of Ms. Debbie Stover indicating dates that the claimant had been coming in for physical therapy and for treatment. The first document indicates dates of alleged treatment between April 5, 1996 and May 20, 1996. The second document indicates dates of alleged treatment between May 21, 1996 and June 14, 1996. Ms. Stover testified that she is the out-patient physical therapy department secretary at Jefferson Regional Medical Center. Ms. Stover testified that she at one point received a telephone call from Ms. Tracey Broyles from Acordia seeking to verify mileage reports sent in by the claimant. Among other exhibits attached to Ms. Stover's deposition is a letter dated March 11, 1997, from Tracey Broyles to Debbie Stover, seeking Ms. Stover's assistance in determining what dates the claimant actually attended physical therapy. Ms. Stover testified that she was the only person in physical therapy responsible for completing documentation on mileage forms. Ms. Stover testified that she did not give the claimant any blank forms which would have included her signature on the form prior to completion, and Ms. Stover testified that the claimant did not attend each and every physical therapy session indicated on the forms at issue. Instead, Ms. Stover testified that her records indicate that the claimant attended approximately one week's worth of physical therapy beginning on March 19, 1996 and continuing through March 28, 1996. Ms. Stover testified that she did complete the form for that period, but that she did not sign those forms in the record which indicate that the claimant attended physical therapy for periods between May 5, 1996 through May 20, 1996 or for the period May 21, 1996 through June 14, 1996. Ms. Stover testified that no one on her staff completed those documents and that she has verified with her staff that no one in her staff completed those documents. Ms. Stover testified that she did give the claimant the original copy of the document which she filled out indicating that the claimant had attended physical therapy beginning on March 19, 1996 and continuing through March 28, 1996. Ms. Stover testified that according to her records, the claimant last attended physical therapy on April 2, 1996, so that the claimant did not attend physical therapy during any of the period that the claimant sought mileage reimbursement for April 5, 1996 through May 20, 1996 or for the period that the claimant sought mileage reimbursement between May 21, 1996 and June 14, 1996.

c. Off Work Slips .

The record contains several copies of a certificate to return to work purportedly under the signature of Dr. Charles Watson dated March 6, 1997. Dr. Watson's testimony indicates that the copies which are validly under Dr. Watson's signature take the claimant off work for an additional period of perhaps six to eight weeks, and the altered certificate to return to work document purports to take the claimant off work for an additional sixteen to eighteen weeks. Dr. Watson's testimony indicates that he did not complete the document purporting to take the claimant off work for sixteen to eighteen weeks.

II. Discussion

The parties did not stipulate as what periods of temporary total disability the claimant has already been paid. However, the claimant testified that he began receiving benefits approximately a month after he got hurt and that the respondents stopped paying temporary total disability benefits in June of 1996.

We find that the greater weight of the credible evidence indicates that the claimant's healing period for his work-related elbow fracture ended long before the respondents terminated the claimant's temporary disability compensation in June of 1996. In this regard, we note that Dr. Clark's January 31, 1996 note indicates that the claimant's fracture had healed in good position. With regard to the claimant's alleged work-related ulnar nerve injury in the cubital tunnel, Dr. Moore concluded on June 17, 1996:

Mr. Jones was recently seen by Dr. Reginald Rutherford, a neurologist at the Pain Care Center and it was his opinion that Mr. Jones did not require surgical treatment. In addition, he agreed with my opinion that Mr. Jones' physical examination did not suggest further deterioration of the ulnar nerve function. Examination did not reveal any evidence of muscle weakness. Mr. Jones' sensory examination revealed diminished sensation throughout his hand, not specific to the ulnar nerve. In addition, the sensory examination is a subjective test. On 06/17/96, Mr. Jones underwent a BT validity test which revealed a submaximal effort. [Emphasis added].

It is my opinion Mr. Jones does not have significant evidence of recurrent cubital tunnel syndrome. It is my opinion he should wear an elbow pad and splint as needed. Finally, I discussed Mr. Jones' medical condition as it relates to work. As I have stated in the past, it is my opinion he should consider further education, or vocational rehabilitation. It is my feeling Mr. Jones will have difficulty performing work which requires significant lifting or gripping.

Likewise, in a July 10, 1996, letter to an attorney Bangs in Pine Bluff, Dr. Moore enclosed a copy of his last office note, and indicated that the claimant's impairment rating has remainedunchanged since 1994. As we interpret Dr. Moore's reports, we understand Dr. Moore to have concluded that the claimant did not experience a cubital tunnel syndrome injury, or any aggravation of a preexisting condition, as a result of his work-related 1995 elbow trauma. Therefore, since Dr. Clark also determined that the claimant's fracture had healed long before June of 1996, we find that the claimant has failed to establish that he remained within the healing period for his elbow injury by June of 1996. Consequently, for the reasons discussed herein, we find that the claimant has failed to establish that he is entitled to any temporary disability benefits for his elbow injury, in excess of those temporary disability benefits already accepted and paid by the respondents into June of 1996.

With regard to claimant's alleged reflex sympathetic dystrophy , Dr. Watson apparently saw the claimant for the first time on November 13, 1996, at which time he diagnosed the claimant with reflex sympathetic dystrophy and myofacial pain in the right parascapular area. His treatment plan at that time included physical therapy and a series of sympathetic blocks via the stellate ganglion approach. A certificate to return to work dated March 6, 1997 indicates that the claimant had been under Dr. Watson's care since January 27, 1997, indicated that the claimant would be re-evaluated in six to eight weeks, and indicated that the claimant could return to work with restrictions which included that the claimant cannot use his right arm or hand. After having performed stellate ganglion blocks for a period between January 27, 1997 and March 6, 1997, and after receiving correspondence from Tracey Broyles dated March 6, 1997, Dr. Watson performed additional stellate ganglion block on March 10, 1997, March 13, 1997, and March 19, 1997. It appears from Dr. Watson's deposition testimony that Dr. Watson felt that the claimant reached maximum medical improvement for his alleged reflex sympathetic dystrophy on March 24, 1997, and that this would have been the first occasion that the claimant could have returned to light-duty work because the claimant was attending physical therapy three times a week and coming to Dr. Watson (apparently for stellate ganglion blocks) once or twice a week.

However, we find that the claimant has failed to establish a causal connection between his alleged reflex sympathetic dystrophy symptoms in late 1996, and his work-related elbow fracture sustained in December of 1995. In reaching this conclusion, we initially note that none of the claimant's physicians have ever rendered any opinion as to whether the claimant's alleged reflex sympathetic dystrophy symptoms are causally related to the claimant's 1995 work-related injury. Even if Dr. Watson had rendered an opinion on causation we would likely have been compelled to accord that opinion little or no weight, since Dr. Watson's records contain a completely inaccurate history suggesting that the claimant underwent surgery for the ulnar nerveafter the 1995 injury, when in fact, Dr. Moore's records indicate that he performed the ulnar nerve surgery before the claimant's 1995 surgery. In light of the evidence that the claimant's only surgery occurred before the 1995 elbow trauma, and in light of Dr. Moore's June 17, 1996 report indicating that the claimant did not experience any new deterioration of his ulnar nerve function as a result of the 1995 trauma, we believe that it would require impermissible speculation on our part to attribute the claimant's alleged reflex sympathetic dystrophy to his relatively minor 1995 elbow fracture injury rather than to his preexisting ulnar nerve injury which required surgery. Consequently, on this record, we find that the claimant has failed to meet his burden of proof on this issue.

The administrative law judge awarded the claimant a 10% impairment rating for a mild ulnar nerve entrapment at the elbow based on testimony from Dr. Watson that the claimant's impairment rating of 10% assigned by Dr. Moore was appropriate based on objective medical evidence and relying on Table 16 on Page 57 of the AMA Guides to the Evaluation of Permanent Impairment, 4th Edition. The administrative law judge awarded this impairment despite the fact that it was based upon reliance of a forged document, that both Dr. Moore and Dr. Clark assessed a 0% rating for claimant's December 21, 1995 injury, and Dr. Moore's findings that claimant's complaints after the December 21, 1995 injury were substantially similar to complaints made before the injury. The administrative law judge appears to have found that the claimant experiences a significant ulnar nerve condition as a result of the December 21, 1995 injury.

In our opinion, the administrative law judge has totally misconstrued Dr. Moore's letters dated May 13, 1996, June 3, 1996, and June 16, 1996. We note that on July 10, 1996, Dr. Moore opined that the claimant, in fact, sustained a 0% impairment rating (i.e., no impairment) as a result of his most recent work-related injury. On that basis, it is irrational to conclude that, when Dr. Moore opined that the claimant did not have significant evidence of "recurrent" cubital tunnel syndrome, he was insinuating that claimant sustained a new injury or abnormality. The fact that Dr. Moore assigned the claimant a 0% impairment rating by July 10, 1996, supports exactly the opposite conclusion, i.e., that any symptoms the claimant was experiencing in 1996 were not the result of any additional impairment as a result of claimant's 1995 injury. This interpretation of the record is also supported by Dr. Moore's statement in his May 13, 1996, letter that the claimant's physical examination revealed mild irritation of the ulnar nerve at the cubital tunnel which were similar to the symptoms that he complained of at the time of his discharge on June 13, 1994. Likewise, that letter goes on to state that "if the [nerve conduction] study does not reveal any evidence of a progressive, or recurrent, cubital tunnel syndrome, it is my opinion Mr. Jones will not require any long term treatment or therapy". Consequently, we find that Dr. Moore concluded that the claimant sustained a 0% permanent anatomical impairment as a result of the claimant's 1995 injury.

Likewise, we fail to see how Dr. Watson's reports and deposition testimony would support a conclusion that this claimant has sustained a 10% anatomical impairment rating. As discussed above, Dr. Watson relied on a 10% impairment rating that was allegedly assigned by Dr. Moore. However, the evidence establishes that the alleged 10% impairment rating assigned by Dr. Moore in a forged report dated June 17, 1996, was in fact never given for the claimant's 1995 injury. To the contrary, as discussed above, the record indicates that the claimant was assigned a 10% impairment rating for his prior injury by Dr. Moore in 1994, and on July 10, 1996, Dr. Moore in fact indicated that the claimant's impairment rating at that time was unchanged since 1994. On this basis, we fail to see how either Dr. Moore's or Dr. Watson's records would support a conclusion that this claimant has sustained a 10% anatomical impairment rating as a result of ulnar nerve entrapment in the elbow from the December 21, 1995 incident, as the administrative law judge found. Furthermore, we note that Dr. Clark's March 10, 1997, purported impairment rating of 75% to the right upper extremity or 45% to the body as a whole appears to be based on subjective findings and not objective findings, as required by Act 796. In addition, Dr. Clark indicated that he would assign the claimant a 0% impairment rating for his epicondylar fracture, and Dr. Clark does not seem to base his impairment rating on any alleged new ulnar nerve entrapment. Instead, Dr. Clark appears to base his impairment rating on subjective symptoms and range of motion testing. Moreover, Dr. Clark purports to rely on Table 11, Chapter 3, Page 48 of the AMA Guides to the Evaluation of Permanent Impairment, 4th Edition, which determines impairment ratings to the upper extremity based on pain or sensory deficit. In addition, although Dr. Clark purports to assign the claimant a permanent impairment rating for reflex sympathetic dystrophy, a condition which was previously purportedly diagnosed by Dr. Watson, we note that Dr. Watson didnot indicate that the claimant was entitled to a permanent anatomical impairment rating as a result of alleged reflex sympathetic dystrophy symptoms. Thus, on this record, we find that the claimant failed to establish by a preponderance of the credible evidence that he sustained any permanent anatomical impairment as a result of his 1995 injury.

We also find that the respondents are entitled to a credit on the forged 10% anatomical impairment rating paid based on Dr. Moore's altered impairment rating report. In this regard, Tracey Broyles testified in relevant part as follows regarding an alleged payment of a 10% anatomical impairment rating:

Q. Now Tracey as an adjustor you're aware that when a claimant's taken off work by his treating physician, that he may be entitled to TTD benefits.

A. Yes, I am.

Q. And by sending this altered Certificate to Return to Work to you, what do you believe this claimant's incentive was?

A. To obtain off-work worker's compensation benefits primarily.

Mr. Kearney: Objection to Speculation.

Mr. McArty: Okay.

Q. Would he have been entitled to these workers' compensation benefits had he in fact altered this Return to Work Slip?

A. No, sir, we have a permanent partial rating on this person as being a 10%, which we consider that we've overpaid, that we have a credit. (Broyles Dep. 20-21).

As discussed above, we find that the greater weight of the credible evidence establishes that Dr. Moore's 1996 letter purporting to assign the claimant a 10% impairment rating was forged. Consequently, we find that the respondents are entitled to a credit against future liability for erroneous overpayment of a 10% impairment rating from a forged rating report.

III. Conclusion

After conducting a de novo review of the entire record, we find that the greater weight of the credible evidence establishes that the claimant's elbow fracture sustained on December 21, 1995, resolved before the respondents terminated temporary total disability benefits in June of 1996. We further find that the claimant has failed to prove that he sustained any additional anatomical impairment in excess of the 10% anatomical impairment sustained from claimant's previous injury. Therefore, we find that the respondents are entitled to a credit for a 10% anatomical rating to the upper extremity paid by the respondents based on a forged medical document purportedly signed by Dr. Michael Moore and purportedly assigning the claimant a 10% impairment rating on June 17, 1996. In addition, we find that the claimant has failed to establish by a preponderance of the credible evidence that his alleged ulnar neuropathy or his alleged reflex sympathetic dystrophy condition, for which he sought additional treatment in approximately October of 1996, are causally related to the incident that occurred on December 21, 1995. Consequently, we find that the claimant also failed to prove that he is entitled to the additional temporary disability compensation and medical benefits at issue in this case. Therefore, we find that the decision of the administrative law judge must be reversed. Due to the numerous fraudulent documents in this case, we are referring this claim to the Arkansas Workers' Compensation Fraud Unit for investigation.

IT IS SO ORDERED.

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