12-0088. MABLE GIBBONS Employee v. ANCHORAGE SCHOOL DISTRICT Self Insured Employer.

Alaska Workers Compensation Decisions 2012. Workers' Compensation Board 12-0088. MABLE GIBBONS Employee v. ANCHORAGE SCHOOL DISTRICT Self Insured Employer ALASKA WORKERS' COMPENSATION BOARDP.O. Box 115512 Juneau, Alaska 99811-5512 MABLE GIBBONS, Employee, V. ANCHORAGE SCHOOL DISTRICT, Self Insured Employer.AWCB Case No. 200622894AWCB Decision No. 12-0088Filed with AWCB Anchorage, Alaska on May 17, 2012FINAL DECISION AND ORDERMable Gibbons' claim for continuing medical treatment was heard on the written record on May 9, 2012. Joseph Kalamarides represented Ms. Gibbons. Nora Barlow represented Anchorage School District (the District). The record closed on May 9, 2012. ISSUE Ms. Gibbons contends her May 1, 2006 work injury is the substantial cause of her need for medical treatment for her cervical spine. The District contends Ms.Gibbons' need for future treatment is not due to her work injury, and, consequently, she is not entitled to further medical benefits. Is the May 1, 2006 work injury the substantial cause of Ms. Gibbons need for medical treatment for her cervical spine? FINDINGS OF FACT The following findings of fact and factual conclusions are established by a preponderance of the evidence: 1) On May 1, 2006, while working for the District, Ms. Gibbons tripped on a carpet runner and fell into a door frame injuring her head, knee, fingers, and back. (Report of Occupational Injury or Illness, May 1, 2006, Gibbons Deposition). Ms. Gibbons was off work the remainder of that day and the next, but then returned to her regular job. (Gibbons Deposition). 2) Prior to the May 1, 2006 injury, Ms. Gibbons sought treatment for neck and shoulder problems on several occasions dating back to at least 1990. (Record). An X-ray in October 1993 revealed "no fractures or subluxations. Spine alignment is satisfactory. Disc spaces are well preserved. Prevertebral soft tissues are not abnormally thickened." (Radiologic Report, October 27, 1993). 3) Cervical spine X-rays taken December 5, 2002 revealed mild multilevel narrowing of the neural foramina from uncal hypertrophy and mid-cervical degenerative changes. (Radiologic Examination Reports, December 5, 2002). 4) An MRI taken on May 3, 2004 showed:
1. Predominately severe neuroformina stenosis bilaterally at the C3-4 and C4-5 levels.
2. Moderate left and mild right neural foramen stenosis C6-7.
3. Mild right neural foramen stenosis at C2-3.
4. Moderate to severe center canal stenosis for the C2-3, C3-4, C4-5 and C5-6 due to combination of disk disease and congenital narrowing of the central canal.
5. Prominent disc disease particularly C3-4 and c4-5 . . . with mild to moderate disk disease at the C5-6 and C6-7 levels. (Alaska Open Imaging, Center, LLC report, may 3, 2004).
5) Cervical spine X-rays taken on June 9, 2004 showed "no significant progression of degenerative changes" when compared to the December 4, 2002 X-rays. (Radiologic Examination Report, June 9, 2004). 6) On July 29, 2004, Ms. Gibbons reported right hand numbness and was diagnosed with right carpal tunnel syndrome. (Chronological Record of Medical Care, July 29, 2004). 7) The first medical record after Ms. Gibbons' May 1, 2006 injury is dated May 18, 2006. The reason for the appointment was "knee concerns." The report notes that Ms. Gibbons had a fall at work two weeks earlier, and "has had persistent [headache], right arm and knee pain since that time. . . . Right arm has good ROM but pt has some difficulty with writing/holding a pen." On examination though her hand strength was intact. (Health Record, May 18, 2006). 8) When she experienced ataxia and an unstable gait, Ms. Gibbons was seen by Kenneth Pervier, M.D. on September 12, 2006. (Dr. Pervier patient information sheet, September 12, 2006). Dr. Pervier referred Ms. Gibbons for several MRIs and CT scans. One of the MRIs, done on October 4, 2006,was of Ms. Gibbons' cervical spine. The report states:
1. Cervical spondylosis and disk protrusions at C3-C4 and C4-C5 with mild to moderate cord compression and either myelomalacia or cord edema.
2. Mild spinal canal stenosis at C5-C6 and C6-C7 secondary to spondylitic changes.
3. Bilateral bony C3-C4 through C6-C7 neural foramen narrowing, all worse on the right.
9) On March 18, 2007, Ms. Gibbons slipped and fell on ice, fracturing her coccyx. (Emergency Care Report, Radiologic Examination Report, March 18, 2007). 10) On April 21, 2007, Ms. Gibbons went to the emergency room at Elmendorf AFB with complaints of chest pain and great difficulty walking. (Narrative Summary, April 26, 2007). Another cervical spine MRI on April 25, 2007 showed "moderate to severe multilevel degenerative disk disease of the cervical spine with cord impingement and signal abnormality at the C3-4 and C4-5 levels. Findings less severe at the C5-6 and C6-7 levels." (Radiologic Examination Report, April 25, 2007). Megumi Vogt, M.D., a neurologist referred Ms. Gibbons to Louis Kralick, M.D., a neurosurgeon. (Narrative Summary, April 26, 2007, Vogt Deposition) 11) On April 27, 2007, Dr. Kralick performed a disc excision as C3-4, C4-5, and C5-6 as well as a vertebrectomy and reconstruction at C4-5. (PAMC Procedure Report, April 27, 2007). On May 2, 2007, Dr. Kralick performed a posterior decompression and fusion from C3 to C6. (PAMC Procedure...

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