Opinion
CLAIM NO. E706130
OPINION FILED MAY 11, 1999
Upon review before the FULL COMMISSION, Little Rock, Pulaski County, Arkansas.
Claimant represented by JIM KING, Attorney at Law, Pocahontas, Arkansas.
Respondent represented by ROBERT H. MONTGOMERY, Attorney at Law, Little Rock, Arkansas.
Decision of Administrative Law Judge: Reversed
OPINION AND ORDER
[2] The respondent appeals a decision of the Administrative Law Judge filed on May 15, 1998, finding that claimant sustained a compensable injury in the course and scope of her employment. Based upon our de novo review of the entire record, we find that claimant has failed to meet her burden of proof.At the hearing held on March 26, 1998, claimant contended that she received an injury as a result of rapid repetitive motion that resulted in carpal tunnel syndrome. Conversely, respondent contended that claimant's carpal tunnel syndrome did not result from her employment. Respondent further contended that claimant's duties with respondent did not involve rapid repetitive motion. After reviewing the evidence impartially, without giving the benefit of the doubt to either party, we agree with respondent. Specifically, we find that claimant has failed to prove by a preponderance of the evidence the compensability of her injury.
Since the claimant asserts that she sustained a work-related gradual onset of carpal tunnel syndrome, the claimant is not required under the provisions of Act 796 of 1993 to establish that her work duties required rapid repetitive motion in order to establish the compensability of her carpal tunnel syndrome injury. See Kildow v. Baldwin Piano Organ, 333 Ark. 335, 969 S.W.2d 190 (1998). However, the claimant must still prove that she sustained a carpal tunnel syndrome injury arising out of and in the course of employment, that a work-related injury is the major cause of her disability or need for medical treatment, and the compensable injury must be established by objective medical findings. See, Id. Consequently, the claimant in this claim is not required to prove that her job duties involved rapid repetitive motion in order to prove the compensability of her carpal tunnel syndrome.
As noted by Dr. Larry Mahon in his independent medical evaluation ordered by the Administrative Law Judge, claimant's primary complaint involved "the thumb and the first ray, with symptoms compatible with deQuervain's tenosynovitis." In this regard, claimant has failed to introduce any objective medical findings supporting a diagnosis of deQuervain's tenosynovitis. At most, we are only provided with claimant's history to Dr. Mahon of her understandings of the EMG/NCV studies and Dr. Mahon's comments that these studies revealed mild electrical changes confirming carpal tunnel syndrome. There is no evidence that these studies support Dr. Mahon's diagnosis of deQuervain's tenosynovitis. Accordingly, we find that she has failed to prove the compensability of the deQuervain's tenosynovitis diagnosed by Dr. Mahon by objective medical evidence.
As noted above, claimant bears the burden of proving that her alleged work-related injury, that is her carpal tunnel syndrome, is the major cause of her disability or need for medical treatment. Ark. Code Ann. § 11-9-102(5)(E)(ii). Claimant's carpal tunnel syndrome has been described as mild. Furthermore, it is not this carpal tunnel syndrome, but rather her complaints of pain about her thumb and "first ray," diagnosed by Dr. Mahon as deQuervain's tenosynovitis, which are causing claimant's disability or need for medical treatment. But for her complaints in her thumb and "first ray" compatible with the deQuervain's tenosynovitis claimant would not be disabled or require medical attention.
As explained by the Court of Appeals in the recent opinionMedlin v. Wal-Mart, 64 Ark. App. 17, 977 S.W.2d 239 (1998) we must consider the alleged compensable injury (in this case carpal tunnel syndrome) not the claimant's work when analyzing the major cause of a claimant's disability or need for treatment. Based upon the evidence in this claim we are constrained to find that claimant has failed to satisfy the major cause requirement. Major cause is defined as more than 50% of the cause. The evidence reflects that more than 50% of the cause for claimant's disability or need for treatment arises out of her complaints of pain in her thumb and first ray, diagnosed as deQuervain's tenosynovitis. Through testing to determine a diagnosis for these complaints, it was discovered that claimant also has mild carpal tunnel syndrome. However, it is not the mild carpal tunnel syndrome which is the cause of claimant's disability or need for treatment. In reaching this finding, we acknowledge that Dr. Mahon has suggested an injection into claimant's carpal tunnel. However, it does not appear from the record that it is claimant's carpal tunnel syndrome which is the major cause of claimant seeking treatment. It is claimant's condition diagnosed by Dr. Mahon as deQuervain's tenosynovitis which is more than 50% of the cause for claimant's disability and claimant's need for treatment.
In finding that claimant has failed to prove the compensability of her alleged carpal tunnel syndrome, we are aware of Dr. Mahon's opinion stating that in his opinion her job duties were the cause of her "present difficulty." Undoubtably the present difficulties (ie. pain in her thumb and "first ray") he was referring to was claimant's deQuervain's tenosynovitis, a condition which is not supported by objective medical findings. As noted above, Dr. Mahon at no time related claimant's alleged carpal tunnel syndrome to her "present difficulty," let alone her disability or need for treatment. Consequently, we are unable to rely upon Dr. Mahon's report when analyzing the major cause requirement. Moreover, the recent holding in Medline v. Wal-Mart, supra, requires us to examine the injury and complaints and not the job duties as Dr. Mahon's did.
The dissent suggests that we have not independently considered claimant's current diagnoses of carpal tunnel syndrome and deQuervain's tenosynovitis. Nothing could be farther from the truth. Both conditions are distinct injuries to the upper extremity. Unfortunately for this claimant her primary complaint and symptoms involve the diagnosis of deQuervain's tenosynovitis, yet she has not substantiated this diagnosis with objective medical findings. Claimant's carpal tunnel syndrome, while documented by objective medical findings, is not the major cause of her disability or need for treatment. It merely appears that in seeking treatment for her deQuervain's tenosynovitis complaints, carpal tunnel syndrome was discovered. In this respect, claimant is fortunate to receive an early diagnosis to possibly prevent her carpal tunnel syndrome from deteriorating.
Accordingly, based upon the record before us at this time, we find that claimant has failed to meet her burden of proof. Specifically, we find that claimant has failed to prove by a preponderance of the evidence that her carpal tunnel syndrome is the major cause of her disability or need for treatment. Therefore, we find that the decision of the Administrative Law Judge must be, and hereby is, reversed.
IT IS SO ORDERED.
_______________________________
DISSENTING OPINION
[15] I respectfully dissent from the majority opinion. In my opinion, claimant sustained a compensable injury.To support their holding, the majority questions whether claimant's carpal tunnel syndrome is attributable to her work-related duties. I find no basis to question the causal relationship. Claimant described her job duties to Dr. Mahon, and he offered the following opinion with respect to causation: "It would appear . . . that the job on which [claimant] was placed in March, 1997, involving a great deal of pulling on shoe material to stretch it, was the cause of her present difficulty." No conflicting evidence exists for Dr. Barre' refused to offer an opinion on the issue of causation. In a chart note dated July 21, 1997, he stated that he "[a]dvised [claimant] that I cannot tell her if she has had a Workman's Comp injury because I did not see her initially for this. I am also not a Workman's Comp physician for Frolic Footwear." Nevertheless, the majority failed to consider this evidence. In the recent case of Patterson v. Frito Lay, Inc., CA 98-1016, slip op. (April 14, 1999), the Court of Appeals stated that "the Commission may not arbitrarily disregard the testimony of any witness." In my view, the majority has done just that.
Next, the majority addresses claimant's diagnosis of deQuervain's tenosynovitis. The majority concludes that without objective findings, claimant failed to prove the compensability of her deQuervain's tenosynovitis. In reaching this conclusion, the opinion appears to question the presence of objective findings to support claimant's diagnosis of carpal tunnel syndrome diagnosis as well. The medical evidence in the record is minimal. However, claimant has a working diagnosis of carpal tunnel syndrome and deQuervain's tenosynovitis. Dr. Larry Mahon conducted an IME on July 29, 1997. According to the report generated from his examination, claimant exhibited symptoms consistent with carpal tunnel syndrome. Moreover, Dr. Mahon noted that he had received and reviewed a copy of the report of the electro-diagnostic studies ordered by Dr. Kumar. Dr. Mahon's report reflects that the objective testing confirmed the diagnosis of carpal tunnel syndrome. The report also reflects that claimant exhibited symptoms consistent with this diagnosis, and Dr. Mahon proposed treatment in the form of an injection.
Then, the majority finds that claimant's carpal tunnel syndrome is not compensable, reasoning that:
Since we find that claimant has failed to prove the compensability of her diagnosed condition of deQuervain's tenosynovitis, we likewise find that claimant has failed to meet the major cause requirement for proving the compensability of her carpal tunnel syndrome.
This line of reasoning is troubling for it suggests that the majority failed to independently consider claimant's concurrent diagnoses. In Tyson Foods, Inc. v. Griffin, 61 Ark. App. 222, 966 S.W.2d 914 (1998), claimant was diagnosed with degenerative arthritis, bilateral carpal tunnel syndrome, and tendinitis. The court affirmed our findings with respect to the compensability of the first two conditions, and our denial of benefits based on a lack of objective findings to support the tendinitis diagnosis. In so holding the Court of Appeals stated:
We do not view Arkansas Code Annotated section 11-9-102 (5) (E) (ii) (Supp. 1997), as precluding a finding that separate injuries or conditions that occur simultaneously or near in time to each other can be compensable. This is true even though the statute requires that both compensable injuries or conditions are the major cause of the disability or need for treatment. Neither does the fact that injuries are located in the same body member, as here, act to disqualify an award of benefits when a claimant meets the statutory requirements of the need for treatment. "Major cause," which is defined as more than fifty percent of the cause, shall be established according to a preponderance of the evidence. Ark. Code Ann. § 11-9-102 (14) (A) (B) (Repl. 1997).
Here, as in Griffin, claimant's symptoms were attributable to more than one condition. The fact that claimant's primary complaints were attributable to deQuervain's does not minimize the diagnosis of carpal tunnel syndrome. Also, as Griffin illustrates, the denial of benefits with respect to one condition is not dispositive with respect to any other condition for which claimant seeks benefits. However, the majority's analysis has inextricably linked claimant's diagnoses of carpal tunnel syndrome and deQuervain's.
Electro-diagnostic testing proved that claimant has carpal tunnel syndrome. Dr. Mahon opined that claimant has symptoms that are compatible with carpal tunnel syndrome. He has recommended treatment for two separate conditions: (1) carpal tunnel syndrome and; (2) deQuervain's. With respect to claimant's carpal tunnel syndrome, Dr. Mahon has proposed injecting claimant's carpal tunnel. This is completely independent of the recommendations he proposed for treating claimant's deQuervain's. Claimant's diagnosis of carpal tunnel syndrome is the sole reason that Dr. Mahon has proposed injecting her carpal tunnel. Since claimant's carpal tunnel syndrome is the sole cause for the proposed injection of the carpal tunnel, the major cause requirement is clearly satisfied. Therefore, I would award all appropriate benefits.
Based on the foregoing, I respectfully dissent.
_______________________________ PAT WEST HUMPHREY, Commissioner