Opinion
CLAIM NO. E909550.
OPINION FILED AUGUST 18, 2000.
Upon review before the FULL COMMISSION, in Little Rock, Pulaski County, Arkansas.
Claimant represented by the HONORABLE R. GUNNER DELAY, Attorney at Law, Fort Smith, Arkansas.
Respondents represented by the HONORABLE WILLIAM FRYE, Attorney at Law, Little Rock, Arkansas.
Decision of the Administrative Law Judge: Affirmed.
OPINION AND ORDER
The respondents appeal an opinion and order filed by the administrative law judge on February 28, 2000. In that opinion and order, the administrative law judge determined that claimant's right carpal tunnel syndrome is a compensable injury within the meaning of the Arkansas Workers' Compensation Act. Claimant was awarded medical benefits. Also, the administrative law judge found that claimant proved entitlement to temporary total and permanent partial disability benefits. After conducting a de novo review of the record, we find that the decision of the administrative law judge must be affirmed.
Claimant worked as a transport driver for this employer. He testified that he worked four days each week. Claimant stated that his duties involved delivering and unloading milk. He testified that the milk is stacked in crates in the trailer. Claimant stated that the crates are stacked in groups of six, and that each crate holds four gallons of milk. He stated that the crates are unloaded using either a "milk hook" or a pallet jack. Claimant testified that a milk hook is a manual jack, which is three feet in length with a diameter that is comparable to a small finger. Until this year, claimant used a milk hook to unload milk crates 90% of the time. He stated that three days per week he used a milk hook. He indicated that he used a pallet jack just one day each week. Currently, most unloading is done with a pallet jack. He explained the difference between using these tools in the performance of his job duties:
The difference is the weight, of course. The milk is all stacked on a pallet with the run I have right now, and I pick it up with the electric jack or the manual jack, which the hydraulics, I guess you'd call it, would pick up a maximum of the weight versus the hook is you've got the individual stacks of milk that's on the floor of the trailer. You have to pull them off by hand and slide them across the floor of the trailer.
Claimant testified that he developed numbness in his right hand in March or April of 1999. Specifically, he noticed the problem during as he was traveling from McAlester to Fort Smith. Concerned that the numbness was attributable to a serious medical condition, claimant informed his supervisor, Lawrence Mirus, that he needed medical attention. He stated that he was advised that the visit would not be covered under workers compensation. Claimant testified that he obtained medical treatment on his own.
Claimant also performs maintenance work on the grounds of his apartment complex. He is responsible for a nine-hole golf course. Claimant works 10-20 hours each week in exchange for discounted rent. He testified that his duties included watering the greens and sharpening the lawn mower blades. He stated that he has worked for the apartment complex for about two years.
The medical evidence included Dr. Thomas E. Cheyne's chart notes. He initially examined claimant on June 10, 1999, and his note contained the following history:
[Claimant] is a 29-year-old who complains of numbness in his right hand and fingers on the radial aspect of the hand. He states this has been going on for several weeks but denies a definite history of injury. However, when asked about his job, he states that he works for Highland [sic] Dairy. He drives an 18-wheeler truck, but does a lot of strenuous pulling and gripping with his hand when he is unloading the milk. He wakes up in the morning with his hand being asleep. He has not had a great deal of pain with this.
Dr. Cheyne ordered electro-diagnostic studies, which were done on June 16, 1999. The testing revealed severe carpal tunnel syndrome on the right side. Based on the test results, Dr. Cheyne referred claimant to Dr. Marvin E. Mumme. He examined claimant on July 27, 1999. In addition to carpal tunnel syndrome, Dr. Mumme also diagnosed a ganglion cyst on claimant's right wrist. He scheduled surgery, which was done on August 16, 1999.
The record also included the deposed testimony of Dr. Cheyne. He stated that when evaluating whether carpal tunnel syndrome is related to the employment of a patient, he determines whether the individual "is doing fairly hand-intensive activity, particularly if it requires gripping or pinching in a repetitive nature or with a fair amount of strength." According to claimant's description, his job involved "a lot of strenuous pulling and gripping with his right hand." He stated that he has viewed a tape of the job, which he characterized as consistent with the description claimant furnished. While viewing the tape, Dr. Cheyne noticed that the individual using the milk hook on the tape engaged in a "pulling motion and manipulating the stack (of milk cartons) into position."
On October 18, 1999, Dr. Cheyne authored a letter stating that claimant's condition was work-related. (This document was ultimately introduced at the hearing). Counsel for respondents questioned him about this matter at deposition. Dr. Cheyne acknowledged that when he wrote the letter, he was unaware of claimant's part-time employment. He agreed that claimant's part-time job could contribute to the development of carpal tunnel syndrome. However, he also pointed out that driving a 18-wheeler truck could contribute to the development of carpal tunnel syndrome. Dr. Cheyne stated that the information revealed by counsel for respondents did not alter his opinion regarding causation. In this regard he testified that:
Well, I think any activity we do with our hands, particularly anything of a strenuous or repetitive nature, can contribute in some way, and my opinion about his job related to his carpal tunnel syndrome is just based upon that's where a person spends a large amount of his time day in and day out doing that particular activity, and based on his description and having seen the videotape, I would still believe that his job would be the major contributing factor to developing carpal tunnel syndrome.
Based on claimant's credible testimony and the testimony of Dr. Cheyne, we find that claimant has proved by a preponderance of the evidence that his condition arose out of and in the course of his employment. In this regard, Dr. Cheyne's deposition testimony is particularly persuasive because he remained convinced of the causal connection after receiving additional information from counsel for respondents. Moreover, it is significant that in addition to the patient history, clinical examination, objective findings, Dr. Cheyne also considered a videotape of claimant's job with respect to the causation issue.
We specifically find that claimant has satisfied all elements of compensability for a gradual onset injury in the form of carpal tunnel syndrome. In reaching our decision, we are mindful of the assertion by respondents that claimant failed to satisfy the major cause requirement. Pursuant to Ark. Code Ann. § 11-9-102 (E)(ii) (Supp. 1999), claimant must prove that "the resultant condition is the major cause of the disability or need for treatment." In this regard, the appeal brief filed by respondents states: "the preponderance of the evidence demonstrates that the claimant's job duties were not the major cause of his carpal tunnel syndrome."
The interpretation of the major cause requirement suggested by respondents was specifically rejected by the Court of Appeals in Medlin v. Wal-Mart Stores, Inc., 64 Ark. App. 17, 977 S.W.2d 239 (1998). In Medlin, the court discussed the distinction between the major cause element, and the requirement of a causal nexus between the injury the employment. The Court of Appeals stated:
[claimant] had the burden of proving by a preponderance of the evidence that her carpal tunnel syndrome was the major cause of the disability or need for treatment. . . . The Commission erred as a matter of law in it's application of [the statute] because it required a finding that [claimant's] work, as opposed to her injury, was the major cause of the disability or need for treatment. It appears that the Commission has mistakenly confused the requirements for establishing a causal connection and the added requirement after 1993 that an alleged compensable injury must be the major cause of the claimant's disability or need for treatment where the injury is not caused by a specific incident or identifiable by time and place of occurrence. These are two distinct requirements that do not coincide with each other.
Claimant consulted Dr. Cheyne in June of 1999 for his hand symptoms. Suspecting carpal tunnel syndrome, he ordered electro-diagnostic studies. Also, medication and a cock-up splint were prescribed. Diagnostic testing done in June of 1999 confirmed Dr. Cheyne's diagnosis, and claimant was referred to Dr. Mumme. Dr. Mumme recommended surgical intervention. This was done in August of 1999. According to the operative report, Dr. Mumme performed a carpal tunnel release. A ganglion cyst was also excised during surgery. It is apparent from the medical evidence that claimant's carpal tunnel syndrome was the major cause of his need for treatment for the release surgery, and his resulting disability. Accordingly, the major cause requirement is satisfied.
Claimant seeks temporary total disability benefits. InRaymond L. Armstrong v. Wheeler Constr. Co. Full Commission Opinion filed May 26, 2000 ( E615744), we held that Act 796 altered the analytical framework for proving entitlement to temporary total disability benefits for scheduled injuries. We stated that "the claimant must establish two requirements by a preponderance of the evidence in order to be entitled to temporary total disability benefits for a scheduled injury: (1) that he remains within his healing period; and (2) that he has not returned to work."
The evidence supports an award of benefits from August 16, 1999, through October 17, 1999. Claimant testified that he was excused from work one day prior to surgery. According to an operative report contained in the record, claimant's surgery was performed by Dr. Mumme on August 16, 1999. He testified that initially, Dr. Mumme estimated that he would require a post-surgical recuperative period of four weeks. In this regard, the record contained a "Return to Work" slip completed by Dr. Mumme on August 9, 1999, which corroborates claimant's testimony. However, claimant's release date was revised. He testified that during a checkup which occurred two weeks after the operation, Dr. Mumme indicated that he would be off for six additional weeks (until October 17, 1999). The evidence showed that claimant has satisfied the Armstrong test.
Claimant contends that he is entitled to reasonable and necessary medical benefits for the treatment of his work-related injury. Respondents must furnish reasonable and necessary medical care for the treatment of compensable injuries. Ark. Code Ann. § 11-9-508 (Repl. 1996). A determination of what constitutes reasonably necessary medical treatment is a fact question for the Commission to resolve. See Gansky v. Hi-Tech Eng'g., 325 Ark. 163, 924 S.W.2d 790 (1996). Claimant sought medical care after developing symptoms in his right hand. According to electro-diagnostic testing ordered by Dr. Cheyne, claimant was diagnosed with "severe" right carpal tunnel syndrome. Based on these results, Dr. Cheyne referred claimant to a surgeon. Dr. Mumme performed surgery in August of 1999. In a chart note dated December 7, 1999, Dr. Mumme indicated that the electro-diagnostic studies were repeated and claimant demonstrated a "marked improvement." In our opinion, claimant has demonstrated that the medical care he received was reasonably necessary for the treatment of his work-related injury.
It is claimant's contention that he is entitled to an award of permanent partial disability benefits. Dr. Mumme assigned an impairment rating of 10%. His chart note specifically stated that he used the "4th Edition of the Impairment Guides." The rating is based on the results of objective testing, and comports with the Act. Accordingly, we find that claimant has met his burden of proof.
Based on our de novo review of the record, and for the foregoing reasons, we specifically find that claimant sustained a compensable injury in the form of carpal tunnel syndrome. Claimant is entitled to related medical benefits. He has also proved entitlement to temporary total disability benefits from August 16, 1999 through October 17, 1999. Accordingly, the decision of the administrative law judge must be affirmed.
All accrued benefits shall be paid 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. § 11-8-809 (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 (Repl. 1996).
IT IS SO ORDERED.
______________________________