VIRGINIA: IN THE WORKERS COMPENSATION COMMISSION

Transcription

1 VIRGINIA: IN THE WORKERS COMPENSATION COMMISSION Opinion by NEWMAN Commissioner RICHARD D. ROACHE v. C. D. HALL CONSTRUCTION, INC. COMMONWEALTH CONTRACTORS GROUP SELF- INSURANCE ASSOCIATION, Insurance Carrier THE LANDIN COMPANIES, Claim Administrator Jurisdiction Claim No Claim Administrator File No Date of Injury: November 15, 2007 Sept. 26, 2014 Bryn Swartz, Esquire Geoffrey R. McDonald, Esquire For the Claimant. Esther King, Esquire For the Defendants. REVIEW on the record by Commissioner Williams, Commissioner Marshall, and Commissioner Newman at Richmond, Virginia. The defendants request review of the Deputy Commissioner s May 2, 2014 Opinion finding them responsible for payment of three additional interferential stimulators prescribed by the treating physician. We AFFIRM. 1 I. Material Proceedings The claimant injured his left foot and leg in a compensable work accident on November 15, The Commission entered an award of lifetime medical benefits and various periods of wage loss benefits, the latest a continuing award of temporary total disability benefits beginning December 21, Considering the issues involved and the complete record developed at the hearing and before the Commission, we find oral argument is unnecessary and would not be beneficial in this case. Va. Workers Comp. R. 3.4; see Barnes v. Wise Fashions, 16 Va. App. 108, 112, 428 S.E.2d 301, 303 (1993).

2 On March 27, 2013, the claimant filed a letter claim seeking authorization and payment for three stimulators recommended by Dr. Paul M. Spector, pain management specialist, as well as medical coverage for his entire body. The defendants defended the claim on the grounds that there was no specific diagnosis to support the request for medical treatment of the entire body; the only recognized injury was a left foot fracture with reflex sympathetic dystrophy (RSD); the medical evidence did not support the claim for medical treatment; and only one of the stimulators was causally related to the work injury. The Deputy Commissioner denied the claimant s claim for injuries to the entire body. The Deputy Commissioner found that the claimant proved he suffered from complex regional pain syndrome (CRPS)/RSD arising from his crush injury and that the defendants were responsible for the multiple interferential stimulators recommended by Dr. Spector. The Deputy Commissioner reasoned: The defendants agree that the claimant suffered a crush injury to the left foot with resulting RSD. The claimant came under the care of Dr. Paul Spector who now recommends the use of multiple interferential stimulators. The claimant requests that the Commission find that he should receive medical coverage for the entire body, including the left side, upper quadrant, as well as swelling and color changes to the skin. After considering the testimony and the medical evidence in this case, the Commission concludes that a finding that the claimant now suffers from conditions of the entire body related to the left foot injury is not supported by the evidence. Therefore, that particular portion of the claim is DENIED. However, Dr. Paul Spector, as the claimant s long-time physician, testified that the claimant now suffers from complex regional pain syndrome (CRPS)/RSD arising from the crush injury, which should be treated by multiple interferential stimulators. Dr. Spector s testimony is found persuasive and credible that this particular treatment aspect is reasonable, necessary, and casually related to the 2

3 (Op. 6-7.) compensable injury, given the claimant's multiple pain complaints, which developed from the original injury. It is the Commission s opinion that the claimant has proven by a preponderance of the evidence that this treatment is the responsibility of the defendants and that the CRPS extends beyond the left foot area. However, the Commission would not find that it results in a conclusion that one-hundred percent of his body is affected, as alleged. The defendants timely requested review. II. Summary of Evidence Dr. Spector first treated the claimant on January 11, 2011, for evaluation of chronic intractable pain in his left foot and generalized pain all over his body. Dr. Spector diagnosed status post injury to the claimant s left foot, with a fracture and crush injury; advanced CRPS generalized throughout his body particularly in the left lower extremity, both upper extremities, and to some extent the right lower extremity; and chronic intractable pain generalized throughout his body. Dr. Spector testified at the hearing that the pain altered body mechanics and it went up his left lower extremity and eventually caused altered body mechanics in his right low back and up in his thoracic region. This produced further chronic pain in other areas which developed an inflammatory process which led to disseminated pain. (Tr. 6.) He agreed that the constellation of pain which is spread to other parts of [the claimant s] body [was] directly related to his crush injury to his foot. (Tr. 6.) In October 2011, Dr. Spector noted that Dr. John M. Barsanti, pain management specialist, had ordered a radiofrequency stimulator. On April 6, 2012, Dr. Spector noted that he was planning to try the claimant on a new interferential unit that might not involve as big a box and... also might be more effective. On May 1, 2012, Dr. Spector reported that he had fitted 3

4 the claimant with an interferential stimulator today and went over place [u]ses. Dr. Spector reported: After the stimulator was put on he was able to bend his left knee and wiggle his toes. This was quite amazing I had not been able to see him doing this before. He felt no discomfort or pain from the unit itself. Placement of the electorate pads around the [sic] gave him a large amount of pain reduction. 54 units he might be significantly relieved of his pain and also the embarrassment of looking like a suicide bomber could be reduced. On May 16, 2012, Dr. Spector noted the claimant had significant improvement with the new stimulator. Dr. Spector authored a June 20, 2012 letter of medical necessity for the interferential stimulator. On August 21, 2012, Dr. Spector wrote another letter of medical necessity in which he opined that the claimant needed four stimulators with a belt holster. He wrote, [The claimant] had made amazing progress with these four machines. On September 20, 2012, Dr. Spector reported that the claimant s stimulator was working well and he was making some really great improvements. In his notes of October 30, 2012, Dr. Spector wrote: [The claimant] notes that the interferential stimulator I gave him was quite good but he cannot function well without use of the interferential stimulators x4. He has them turned up all the way to the maximum setting He needs an interferential stimulator x4 and a belt so that he does not have to put the stimulators in his pockets. On June 19, 2013, the claimant reported his pain was helped by the stimulators. Dr. Spector recommended therapy, which could only be done with the assistance of multiple interferential stimulators. On July 13, 2013, the claimant reported he felt like he could do so much more with the interferential stimulators on. Dr. Spector s July 24, 2013 notes reflect that 4

5 the claimant s RSD is in his left lower extremity and has spread up through other areas of his body. On August 20, 2013, Dr. Spector noted the claimant had evidence of disseminated CRPS and/or RSD. On October 31, 2013, Dr. Spector s notes reflect that the claimant was using a cane instead of a walker. He reported that the four stimulators were helping him walk. The claimant also treated with Dr. Karanvir V. Prakash, orthopedic surgeon, on referral from Dr. Spector. Dr. Prakash evaluated the claimant on October 4, The claimant reported pain in his left foot since his work injury and that the pain had spread over his body. Dr. Prakash diagnosed midfoot arthritis secondary to injury superimposed on RSD. He recommended a midfoot fusion. On May 30, 2012, Dr. Prakash recommended a tarsal tunnel release, which he eventually performed. On January 29, 2013, Dr. Prakash noted the claimant complained his whole body hurts. Dr. Prakash opined: Patient has reached maximum medical improvement, his FCE was reviewed and patient is capable of very, very sedentary work, although is in significant pain, this precludes him from any work, he is required to have a TENS unit as he has significant pain all over his body secondary to the crush injury activating a generalized RSD syndrome. On October 4, 2013, Dr. Yingxue Zhang, rheumatologist, evaluated the claimant for a defense medical examination. His history stated: This patient is a 45 y.o. year old male referred by Esther King from Blair Law Offices to evaluate general swelling of both arms and legs, left foot, left chest wall and pain all over body, which started in He suffered a work-related injury on November 15, 2007 when a steel hydraulic bucket slipped off during an attachment procedure, landing on his left foot. He was diagnosed a crush injury to the foot with damage to the dorsal muscles of the foot and nerves. He developed chronic regional pain syndrome of his left foot and ankle and has been followed by pain management Dr. Spector. He has noticed his pain gradually spreads to his entire body and became more severe. He also feels swelling of his 5

6 all extremities as well as left chest wall worse for over 1-2 years. He has also had weight gain about 70 lbs in the past several years. He has received 3 NexWave interferential Stimulators to use all over his body. He also uses Flector patch, pennsaid and takes gabapentin arid methadone by Dr. Spector. He also follows by orthopaedic surgeon Dr. Prakash and several other orthopaedic surgeons for his left foot and ankle injury. Dr. Zhang s assessment included: [H]istory of crush injury to the foot and subsequently developing chronic regional pain syndrome. His pain gradually spreads to his all body with all body pain and feels extremities swelling. On exam, diffuse tenderness of all body including in fibromyalgia distribution... III. Findings of Fact and Rulings of Law While the defendants concede that the claimant suffers from causally related RSD and CRPS in the left lower extremity, they argue that the evidence does not support amending the award any further. They also argue that the Deputy Commissioner erred in finding them responsible for payment of three additional interferential stimulators where one was enough to treat the claimant s left leg. The Deputy Commissioner did not amend the award to include the entire body. He simply held that the evidence supported a finding that the claimant s CRPS/RSD had spread beyond the area of his original injury and that the four interferential stimulators prescribed by Dr. Spector were reasonable, necessary, and causally related to his work injury. We agree with these findings. It is the claimant s burden to prove that each requested medical expense is causally related to the accident, and reasonable and necessary for treatment of his compensable injuries, and that the medical service was rendered by or on referral by an authorized treating physician. See Va. Code ; Volvo White Truck Corp. v. Hedge, 1 Va. App. 195, 199, 336 S.E.2d 6

7 903, 906 (1985). Where an authorized treating physician has prescribed specific medical treatment, the defendants, not the claimant, have the burden to prove by a preponderance of the evidence that the prescribed treatment is neither reasonable nor necessary. Sheffer v. Flint Ink Corp., VWC File No (Aug. 14, 2006) (citing Jensen Press v. Ale, 1 Va. App. 153, 159, 336 S.E.2d 522, 525 (1985) ( the employer is financially responsible for the medical attention which the attending physician deems necessary, subject to review by the Commission. )). Here, Dr. Spector recommended four interferential stimulators to treat the claimant s CRPS/RSD and chronic pain, which he opined were causally related to his original work injury. Dr. Spector opined the stimulators were necessary to treat the claimant s pain, and their use had increased the claimant s mobility and decreased his pain, allowing him to be more active. There is no medical opinion to the contrary. Thus, based on this evidence, we agree with the Deputy Commissioner that the interferential stimulators prescribed by Dr. Spector are reasonable, necessary, and causally related medical treatment for which the defendants are responsible. IV. Conclusion The Deputy Commissioner s May 2, 2014 Opinion is AFFIRMED. This case is removed from the review docket. APPEAL You may appeal this decision to the Court of Appeals of Virginia by filing a Notice of Appeal with the Commission and a copy of the Notice of Appeal with the Court of Appeals of Virginia within 30 days of the date of this Opinion. You may obtain additional information 7

8 concerning appeal requirements from the Clerks Offices of the Commission and the Court of Appeals of Virginia. 8