Opinion
CLAIM NO. E814766
ORDER FILED MARCH 16, 2001
Upon review before the FULL COMMISSION in Little Rock, Pulaski County, Arkansas.
Claimant represented by the HONORABLE SILAS H. BREWER, Attorney at Law, Little Rock, Arkansas.
Respondents represented by the HONORABLE THOMAS J. PENDOWSKI, Attorney at Law, Little Rock, Arkansas.
Decision of the Administrative Law Judge: Vacated and remanded.
OPINION AND ORDER
Claimant appeals an opinion and order filed by the Administrative Law Judge on July 19, 2000. In that opinion, the Administrative Law Judge entered the following findings of fact and conclusions of law:
1. The stipulations agreed to by the parties at the pre-hearing conference conducted on March 30, 2000, and contained in the pre-hearing order filed that same date, are hereby accepted as fact.
2. On September 16, 1998, the claimant sustained a compensable injury to his right hip, right leg, and right shoulder.
3. Claimant has failed to prove by a preponderance of the credible evidence that his muscle spasms are causally related to, arose out of, and/or is a compensable consequence of his compensable injury of September 16, 1998.
4. Claimant has failed to prove by a preponderance of the credible evidence that his compensable injury of September 16, 1998, is the major cause of the muscle spasms suffered by him.
5. That claimant has failed to prove by a preponderance of the credible evidence that his need for medical treatment after September 17, 1998, was causally related to the September 16, 1998 injury.
6. That claimant has failed to prove by a preponderance of the credible evidence that his compensable injury of September 16, 1998, is the major cause of his need for medical treatment after September 17, 1998.
7. That claimant did not sustain any impairment and/or disability as a result of his September 16, 1998 injury.
8. That claimant has failed to prove by a preponderance of the credible evidence that the September 16, 1998 injury has resulted in a physical impairment supported by objective and measurable physical findings in accordance with A.C.A. § 11-9-704(C)(1).
9. That the respondent has denied and controverted claimant's entitlement to any benefits attributable to the September 16, 1998 injury.
10. That the respondent is ordered to pay all reasonable and necessary medical expenses incurred by the claimant on September 16 17, 1998, in the transport of the claimant for receipt of medical services, delivery of medical services, and treatment by his family physician relating to the injury sustained to the claimant's right hip, right leg, and right shoulder.
11. That all muscle spasms suffered by the claimant, treatments, and medications therefor, are the result of claimant's pre-existing condition and are not related to the compensable injury sustained by the claimant; that the claimant has failed to prove by a preponderance of the credible evidence that his muscle spasms and treatment therefor are reasonably necessary and related to his compensable injury of September 16, 1998, and respondent has no obligation therefor.
12. That the maximum statutory attorney's fees are awarded to claimant's attorney on the medical benefits which have been awarded to the claimant herein above, payable one-half by the claimant and one-half by the respondent.
13. That the claim for additional medical treatment and disability benefits is hereby respectfully denied and dismissed.
Based upon the use of an erroneous causation standard, blurring of the issues of compensability and permanency, and the resolution of issues not presented for determination, we find that the decision of the Administrative Law Judge must be vacated and this case remanded for additional findings.
The Administrative Law Judge held that the major cause requirement was not satisfied. Claimant's theory of the case is that he sustained a specific incident injury on September 16, 1998. In addition to other injuries, claimant contends that the fall aggravated his pre-existing fibromyalgia. Therefore, a finding of compensability is not contingent upon claimant's satisfaction of the major cause requirement.
Another difficulty with the Administrative Law Judge's decision is his reliance on Jeter for the proposition that: "except in the most obvious cases, the existence of a causal relationship must be established by expert medical opinion." This standard is inconsistent with appellate court case law. In Wal-Mart Stores, Inc. v. VanWagner, 337 Ark. 443, 990 S.W.2d 522 (1999), the Supreme Court held that "objective medical evidence is necessary to establish the existence and extent of an injury but not essential to establish the causal relationship between the injury and a work-related accident."
Moreover, it appears that the Administrative Law Judge confused the issues of permanency and compensability, using evidence regarding the former to disprove the latter. The parties introduced the deposition testimony of Dr. Joe Lee Buford. In response to an inquiry from claimant's counsel, Dr. Buford testified that claimant's work-related fall aggravated his pre-existing fibromyalgia. Of course, this evidence is relevant to the issue of compensability.
Dr. Buford was also asked to quantify the degree of permanent anatomical impairment attributable to the fall. He was unable to assign a numerical value, indicating that "my gut feeling is that it's a major factor." This is pertinent to an inquiry regarding claimant's entitlement to permanent partial disability benefits. However, it is unrelated to the issue of compensability.
Dr. Buford's inability to assign an impairment rating or quantify the degree to which the pre-existing fibromyalgia was exacerbated by the fall resulted in a finding that claimant failed to meet his burden of proof. However, the issues of compensability and permanency are not inextricably bound.
The pre-hearing identified several issues to be litigated. Before the hearing commenced, its scope was limited. In this regard, the following exchange occurred between the Administrative Law Judge and counsel for claimant:
Q. Administrative Law Judge: And if I understand correctly, before you proceed, as I understand the purpose in this hearing today is to determine compensability. Assuming we get — that I rule subsequent to the hearing on that, that you're going to go ahead and litigate the issue of total — temporary total benefits, medical benefits and attorney's fees, is that correct?
A. Claimant's Counsel: Yes, sir.
Under these circumstances, we vacate the Administrative Law Judge's opinion and remand this cause to the Administrative Law Judge to make additional findings of fact and conclusions of law consistent with this opinion.
IT IS SO ORDERED.
_____________________________ ELDON F. COFFMAN, Chairman
_____________________________ MIKE WILSON, Commissioner
_____________________________ SHELBY W. TURNER, Commissioner