Court: Court of Appeals of Arkansas; February 23, 2011; Arkansas; State Appellate Court
RITA W. GRUBER, Judge, reviewed the appeal by hLVL, Inc. against the Workers’ Compensation Commission's June 1, 2010 decision that awarded Donald Ragsdale additional medical treatment for his December 2006 neck injury, which led to a cervical discectomy and fusion. hLVL’s appeal contended that substantial evidence did not support the 2009 treatment recommendations by anesthesiologist Dr. Raymond Greaser, a pain management specialist. The court affirmed the Commission's decision, emphasizing that a claimant must prove entitlement to additional medical treatment, which can extend beyond the healing period if it is aimed at managing the compensable injury. Arkansas law mandates employers to provide necessary medical treatment for work-related injuries, with the determination of what is "reasonably necessary" being a factual question for the Commission.
Ragsdale, a truck driver, sustained injuries while unhooking a trailer in September 2006. Subsequent medical evaluations revealed significant neck issues, leading to surgery in January 2007, which was covered by LVL. Afterward, Ragsdale was referred to Dr. Greaser for pain management, who, in February 2009, requested preauthorization for neurostimulation therapies due to Ragsdale's chronic pain and failed conservative treatments. Dr. Greaser highlighted the ineffectiveness of previous treatments and argued that investing in the proposed therapies would be more beneficial than continuing ineffective conservative care. An independent medical examination conducted by Dr. Terence P. Braden III on May 4, 2009, was also noted in the context of Ragsdale’s ongoing medical evaluations.
Carpal tunnel release surgery is scheduled for Ragsdale, who has bilateral carpal tunnel syndrome, more severe on the left. In a 2009 independent medical exam, Dr. Braden assigned a 15% permanent impairment rating for radiculopathy. An administrative law judge held a hearing on Ragsdale's entitlement to additional benefits for his neck injury, the occurrence of bilateral carpal tunnel syndrome at that time, and the conformity of Dr. Braden’s anatomical impairment rating with AMA guidelines. Ragsdale testified about his ongoing employment with LVL, expressing the difficulties he faced due to headaches, neck pain, and left arm weakness, and requested additional medical care for pain relief. He noted his inability to take narcotics due to job requirements and that he had tried other medications without success. Ragsdale reported no prior issues with his left hand or arm before the 2006 accident. Post-surgery, he experienced restricted neck movement but noted overall improvement. The law judge found that Ragsdale remained symptomatic from his compensable neck injury, which justified treatment as a reasonable medical expense under Ark.Code Ann. 11-9-508. The judge ordered LVL to pay for Dr. Greaser’s treatment within 30 days. Although both Dr. Braden and Dr. Cathey identified residual radiculopathy at C7, the judge rejected Dr. Braden’s impairment rating for not aligning with Commission precedents. Additionally, Ragsdale failed to prove his carpal tunnel syndrome was work-related, as prior diagnoses from 2002 were not considered. The Commission affirmed the law judge's decision. On appeal, the only issue was the sufficiency of evidence regarding additional treatment for nerve stimulators, with the standard being whether substantial evidence supports the Commission's findings.
The Commission's credibility determinations and resolution of conflicting evidence are recognized as factual matters. LVL's claim that the Commission merely adopted the Administrative Law Judge’s opinion without analysis is unsupported and contrary to Arkansas law, which allows such adoption, making the law judge’s findings those of the Commission. LVL fails to address Dr. Greaser’s assertion that neurostimulation costs less than ineffective conservative measures, and it does not provide adequate legal support for its arguments. LVL specifically contests the sufficiency of evidence linking Dr. Greaser’s recommended procedures to Ragsdale’s compensable neck injury, citing nerve-conduction studies that showed no radiculopathy. It argues that the nerve stimulator was intended for headaches unrelated to the work injury and that the procedures targeted arm issues deemed non-compensable. Despite acknowledging conflicting medical opinions, the Commission interpreted the evidence and concluded that Ragsdale remained symptomatic from the compensable injury and that Dr. Greaser’s recommended pain management was a necessary medical expense. The Commission has the authority to accept or reject medical opinions and draw inferences based on its expertise. Substantial evidence, including credible testimony and expert opinions, supported the Commission's conclusion that the recommended treatment was related to Ragsdale's compensable injury, and the Commission's findings will not be reversed.
In June 2008, Dr. Ricca documented Ragsdale’s complaints of left occipital head pain and left cervical pain radiating to the arm. Dr. Ricca's assessments included headache, cervical post-laminectomy syndrome, cervical spondylosis, chronic pain, chronic postoperative pain, cervicalgia, and cervical radiculopathy. From June to October 2008, Dr. Greaser, the authorized treating physician, noted attempts at conservative pain management, including left greater occipital nerve injections and left posterior C4-7 cervical epidural corticosteroid injections, with ongoing assessments of headache, cervicalgia, and chronic pain. In February 2009, Dr. Greaser highlighted the ineffectiveness of these conservative treatments and medications, requesting neurostimulation therapy as a necessary medical intervention. By October 2009, he reiterated that Ragsdale's work-related accident led to his debilitating condition and that conservative therapies had failed. The determination of medical evidence's weight and interpretation falls to the Commission, which found substantial evidence supporting the award of additional medical treatment as directed by Dr. Greaser. The decision was affirmed, with judges Pittman and Robbins concurring.
