ANDREA SUE SWEENEY V. KING'S DAUGHTERS MEDICAL CENTER, ET AL
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RENDERED : AUGUST 21, 2008
TO BE PUBLISHED
,Sup.twt (gourf of 'za
2007-SC-000885-WC
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ANDREA SUE SWEENEY
V.
APPELLANT
ON APPEAL FROM COURT OF APPEALS
2007-CA-000654-WC
WORKERS' COMPENSATION BOARD NO. 04-68919
KING'S DAUGHTERS MEDICAL CENTER,
HON. GRANT S . ROARK,
ADMINISTRATIVE LAW JUDGE AND
WORKERS' COMPENSATION BOARD
APPELLEES
OPINION OF THE COURT
AFFIRMING
An Administrative Law Judge (ALJ) dismissed the claimant's application for
benefits, finding that she failed to show a permanent, work-related injury . The Workers'
Compensation Board and the Court of Appeals affirmed . Appealing, the claimant
argues that Kentucky should adopt a rule that gives the opinions of a treating physician
greater weight than those of an examining physician . She also argues that the ALJ
misconstrued the law regarding pre-existing injuries and failed to support the decision
with substantial evidence.
We affirm . Neither Chapter 342 nor the applicable regulations affords greater
weight to a treating physician's testimony. Substantial evidence supported the decision
under a correct interpretation of the law.
The claimant was born in 1950 and graduated from college with a degree in
nursing. She began working for the defendant as a Certified Operating Room Nurse in
1995 and began to experience neck and arm pain in 1999. In 2002 she underwent a
right ulnas nerve release and also underwent a spinal fusion at C5-6 . She did not allege
that the symptoms or surgeries resulted from her work. She stated that she returned to
full-duty work without restrictions and that even her migraines ceased after the surgery .
Although she reported neck pain when pushing a stretcher in August 2003 and had xrays, she missed no work .
On September 23, 2004, the claimant felt something pull in her neck and
shoulder while helping to move a patient onto an operating table . Later that day, her
left arm went limp. A physician placed her on light duty for about a week but took her
off work altogether on September 30, 2004. Her application for benefits alleged a
September 23, 2004, cervical spine injury as well as a September 30, 2004, cumulative
trauma injury to the wrists (carpal tunnel syndrome), elbows (ulnas nerve), and back .
The parties stipulated that the employer paid temporary total disability benefits
voluntarily from October 1, 2004, until August 28, 2005, and that it paid about $9,500 .00
in medical expenses .
When the matter was heard, the claimant's Social Security Disability claim was
pending . She stated that she suffered from carpal tunnel syndrome and a separate
ulnas nerve problem, that she dropped things more frequently than before September
2004, and that she suffered from neck spasms, tingling and numbness in her left arm,
and migraine headaches . She argued that the 2004 injuries caused her to be totally
disabled and that she had no prior, active disability . The employer argued that any
injury resolved and caused no permanent harm .
A cervical spine MRI performed iDOctober 2004revealed the
(15-6
fusion, 8(04-
5 posterior disc protrusion that had increased somewhat since 2002, and a possible
C6-7
posterior disc protrusion . The radiologist noted that hardware from the fusion
significantly distorted the field @[ C5-6 but that there was probably greater disc disease
below
in the levels just above and
C5-6 .
Dr. Bajorek reported that nerve conduction
studies performed in December 200z1revealed no evidence of active cervical
r@dicUlopathy. The report noted that the left tardy u1nar palsy was unchanged since
2002 and that there was mild carpal tunnel syndrome CJnfhe right without denervation .
Dr. PoVVeU ` a neurosurgeon, treated the claimant's neck pain and performed the
2002 ffusion surgery . In November 2004 he noted that she had few symptoms after the
work-related injury except occasional neck pain . He also noted that a preliminary
review of the films showed nothing outstanding . In May 2006 Dr. Powell, noted
complaints ofdropping things (primarily with the left hand), of ongoing pain and spasm,
and of developing migraines after traveling any distance in 8 Car. He reported that @ reexamination revealed weakness in the left hand but noted that there was no reflex
abnormality and a non-deFDl@tqrD@) pattern for sensory loss . He also noted that the
most recent MFU was unchanged from 2004 and revealed no definite evidence of nerve
compression . Dr. P'C)VVell diagnosed cephalgia l secondary to the work injury . He did
not recommend surgery but stated that the claimant was unable to return to nursing
duty that required lifting or prolonged chart work and attributed her present condition to
her work. He recommended that she retire .
1
a headache .
362 /19m ed .2001\ .defines ceph@{gia as being
Dr. BOVer, @neurosurgeon, reviewed the 2004 cervical spine MRI . He reported
minimal bulging at C5-6. He also reported that the nerve conduction studies revealed
no n8dicUlOD8thV .
Dr. Bell, who is Board Certified in physical medicine and rehabilitation, provided
pat management therapy. He reported in July 2006 that the claimant's diagnoses
included the C5-6 fusion, cervical GpoDdVlO8is ' cervical r@dicUlitis ` mild u1nar palsy, and
excellent but brief relief from symptoms with treatment . In his opinion, she was
permanently and totally disabled from nursing or any other occupation for which she
was qualified. He declined to address causation or pre-existing changes, stating that
they required neurosurgical expertise .
[)[Herrevaluated the claimant for her attorney in April 2006. He attributed a
heOlia ƒed cervical disc at C4-5 to the injury, assigned a :28% permanent impairment
rating based on the cervical spine, and stated that no portion of the impairment was
active before the work-related incident. When deposed, he acknowledged that an
artifact from fhe fusion hardware obscured the disc space on MRI so that he could not
state deNDitiVe{y that the C4-5 disc was herniated . He stated that such @ he[Oi@tiOn
would be consistent with the "known statistical behavior' of cases in which there is "a
symptomatic apparent surgical failure . . . after a surgical spine fusion ." He reported
some physical findings that were consistent with G3dicUlopathVbUt acknowledged that
the most recent nerve conduction study showed no evidence of a cervical spine or
upper extremity radicUlop8thV. He also acknowledged that the 2002 fusion warranted a
permanent impairment rating under DIRE Cervical Category f\/. o He explained that he
2
The Fifth Edition of the AMA Guides to the Evaluation of Permanent Impairmen , page
392 . indicates that {]IRE Cervical Category IV warrants @ 25-28% permanent
4
characterized no portion of the 28% rating as being prior, active impairment because
the claimant was released to work without restrictions after the fusion .
Dr. Rice, a board-certified family physician, evaluated the claimant for her
attorney in May 2006 . He diagnosed a herniated cervical disc at C4-5 based on MRI .
Dr. Rice attributed the condition to the injury at work and noted that repetitive trauma to
the claimant's hands and shoulders over 27 years produced carpal tunnel syndrome
and arthritis. He assigned a 15% permanent impairment rating to the C4-5 herniation
under Tables 15-6 and 15-15, stating that there was no active impairment before the
work-related incident . 3 When deposed by the employer, he stated that he found
evidence of radiculopathy on physical examination and attributed the negative findings
on the nerve conduction study to her body position during the study. He acknowledged
that the 2002 fusion resulted in an "alteration of motion segment integrity" and
warranted a 25-28% permanent impairment rating under DRE Cervical Category IV.
Dr. Sheridan, an orthopedic surgeon, evaluated the claimant for the employer in
August 2005 . He noted that she had had undergone a right u1nar nerve release due to
bilateral upper extremity pains and paresthesias in 2002, before the C5-6 fusion . He
noted that the 2004 MRI revealed the fusion as well as some bulging at C4-5 . In his
opinion, the incident at work caused only an acute cervical strain that resolved and
warranted no permanent impairment rating. He thought that she could return to her
former work without restrictions .
Dr. Best, an orthopedic surgeon, evaluated the claimant for the employer in May
impairment rating .
3
Table 15-6a addresses corticospinal tract impairments to the upper extremities due to
spinal cord injury. Table 15-15 is a spine evaluation summary. Dr. Rice did not
explain how he arrived at a 15% rating under the two tables .
5
2006 .
He noted that physical examination revealed a submaximal and inconsistent
effort on her part, no loss of reflex or atrophy, and no objective evidence of a specific
abnormality. He reported that she was at maximum medical improvement, that a 2528% permanent impairment rating resulted from the 2002 surgery, and that the injury
on September 23, 2004, caused no specific abnormality or change of condition . In his
opinion, the claimant could return to work as a nurse . He noted in a supplemental
report that the fusion hardware obscured less of the cervical spine on the 2006 MRI
than it had on the previous MRI due to an improvement in technology . The 2006 MRI
showed no disc herniation, foramenal stenosis, or nerve root impingement at any level .
He also noted that neither the two neurosurgeons who testified nor the two orthopedic
surgeons found any documented cervical radiculopathy on physical exam .
After reviewing all of the medical evidence, the AU focused on the testimony by
the four independent evaluators, Drs . Herr, Rice, Sheridan, and Best . The AU found
the opinions of Drs. Sheridan and Best to be most persuasive, noting that Drs. Herr and
Rice assigned no pre-existing, active impairment despite the fusion surgery and also
that no objective findings showed the existence of a new, permanent injury to warrant
permanent benefits . Thus, the AU dismissed the claim .
KRS 342 .0011(1) defines a compensable injury as being a work-related
traumatic event that is the proximate cause producing a harmful change in the human
organism as evidenced by objective medical findings . The claimant alleged the
September 23, 2004, cervical spine injury as well as a cumulative trauma injury to he
wrists (carpal tunnel syndrome), elbows (ulnar nerve), and back. Thus, she had the
burden to prove every element of her claim .4
The claimant urges to court to give greater deference to the treating physicians'
testimony based on Walker v. Secretary of Health and Human Services , 980 F.2d 1066,
1979(6 t" Cir. 1992), and other authority regarding Social Security Disability claims.
Walker explains that federal social security regulations entitle a treating physician's
opinion to substantial deference and entitle it to complete deference if it is
uncontradicted . Thus, the claimant's argument is misplaced in the context of a
Kentucky workers' compensation claim, which is governed by Chapter 342 and the
applicable regulations .
As noted in Miller v. East Kentucky Beverage/Pepsico, Inc. , 951 S .W.2d 329,
331 (Ky. 1997), KRS 342.185 gives the AU the sole authority to judge the weight,
credibility, and inferences to be drawn from the evidence of record . The court
determined earlier in Wells v. Morris , 698 S .W .2d 321, 322 (Ky. App . 1985), that
nothing requires an AU to give greater weight to a treating physician's testimony.
Although the legislature later amended KRS 342 .315(2) specifically to require an AU to
afford a university evaluator's clinical findings and opinions presumptive weight,
Chapter 342 and the regulations continue to be silent regarding the weight to be
afforded a treating physician's testimony. We construe that silence as a legislative
intent to give it no particular weight.
The AU dismissed the claim based on the testimonies of Drs. Sheridan and
Best. Dr. Sheridan found only a temporary injury that resolved . Dr. Best reported that
the 2006 MRI showed no disc herniation, foramenal stenosis, or nerve root
4
Roark v. Alva Coal Corporation , 371 S .W .2d 856 (Ky. 1963); Wolf Creek Collieries v.
Crum , 673 S .W.2d 735 (Ky. App. 1984) ; and Snawder v. Stice , 576 S .W.2d 276 (Ky.
7
impingement at any level, which together with the nerve conduction studies negated the
basis for the permanent impairment rating that Dr . Rice assigned . Although Dr. Herr
attributed a 28% rating under DRE Cervical Category IV entirely to the September 2004
injury, uncontradicted evidence indicated that the previous, non-work-related cervical
fusion, by itself, would warrant a 25-28% rating. Thus, the decision was reasonable
under the evidence. Special Fund v. Francis, 708 S.W .2d 641, 643, explains that a
reasonable decision may not be reversed on appeal .
Finally, the AU did not misapply the law regarding pre-existing conditions .
McNutt Construction/First General Services v. Scott, 40 S.W .3d 854, 859 (Ky . 2001),
stands for the principle that "[w]here work-related trauma causes a dormant
degenerative condition to become disabling and to result in a functional impairment, the
trauma is the proximate cause of the harmful change; hence, the harmful change
comes within the definition of an injury. ,5 It is inapplicable in the present situation
because the AU relied on medical evidence that work-related trauma caused no
permanent harm and because no overwhelming medical evidence compelled otherwise .
The decision of the Court of Appeals is affirmed .
Minton, CJ, and Abramson, Cunningham, Noble, Schroder, and Scott, JJ .,
concur . Venters, J., not sitting .
App. 1979).
5 See also Ingersoll-Rand v. Edwards , 28 S .W .3d 867 (Ky. 2000) .
8
COUNSEL FOR APPELLANT,
ANDREA SUE SWEENEY:
GEORGE C. PERRY, III
P.O. BOX 900
PAINTSVILLE, KY 41240
COUNSEL FOR APPELLEE,
KING'S DAUGHTERS MEDICAL CENTER:
A. STUART BENNETT
JACKSON KELLY, PLLC
175 EAST MAIN STREET
SUITE 500
P .O . BOX 2150
LEXINGTON, KY 40588-9945
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