ROSA CASTRO, Claimant,
v.
COLLEGE OF SOUTHERN IDAHO, Employer,
and
IDAHO STATE INSURANCE FUND, Surety, Defendants.
Nos. IC 2016-033930, IC 2017-009800
Idaho Workers Compensation
Before the Industrial Commission of the State of Idaho
April 9, 2019
FINDINGS OF FACT, CONCLUSIONS OF LAW, AND
RECOMMENDATION
Thomas
P. Baskin, Chairman.
INTRODUCTION
Pursuant
to Idaho Code § 72-506, the Idaho Industrial Commission
assigned the above-entitled matter to Referee Brian Harper,
who conducted a hearing in Twin Falls, Idaho, on July 17,
2018. Dennis Petersen of Idaho Falls represented Claimant.
Paul Augustine of Boise represented Defendants. The parties
produced oral and documentary evidence at the hearing, took
post-hearing depositions, and submitted briefs. The matter
came under advisement on January 22, 2019.
ISSUES
The
issues noticed for resolution at hearing were:
1. Whether Claimant’s low back condition for which she
seeks additional benefits was caused by either or both of her
industrial accidents;
2. Whether and to what extent Claimant is entitled to the
following benefits:
a. Medical care;
b. Temporary disability benefits1 ; and
3. Whether Claimant is entitled to a change of physician to
Dr. Benjamin Blair.
All
other issues are reserved.
CONTENTIONS
OF THE PARTIES
Claimant
contends she suffered injury to her low back as the result of
one or two falling accidents while in the course and scope of
her employment. These accidents occurred on November 14 and
December 22, 2016. After Surety declared Claimant at MMI, she
saw Dr. Benjamin Blair for her continuing low back
complaints. Dr. Blair recommended lumbar surgery, and
attributed the need for such surgery entirely to
Claimant’s industrial accidents. Defendants denied the
surgery. Claimant is entitled to continuing medical care as
proposed by Dr. Blair, including surgery. Claimant also
asserts Dr. Blair should be designated as Claimant’s
treating physician moving forward.
Defendants
argue that Claimant has not proven she suffered an injury to
her low back that requires lumbar surgery from either or both
of her industrial accidents. Claimant had preexisting low
back arthritis, and at most strained her back in the work
accidents, which strain has resolved. Claimant’s
ongoing symptomatology is due to conditions unrelated to her
work accident. Her radicular leg pain is subjective, and not
correlated by objective MRI findings. Furthermore, Dr.
Blair’s opinions are based on Claimant’s
unreliable, inaccurate history.
EVIDENCE
CONSIDERED
The
record in this matter consists of the following:
1. The testimony of Claimant taken at hearing;
2. Joint exhibits (JE) A through X admitted at hearing; and
3. The post-hearing deposition transcripts of Benjamin Blair,
M.D., and Paul Montalbano, M.D., taken on September 5, and
October 17, 2018, respectively.
FINDINGS
OF FACT
1. At
the time of hearing Claimant was a 54 year old married woman
living in Rupert, Idaho.
November
Accident
2. In
November 2016 Claimant worked for Employer as a
teacher’s assistant helping teach children in the
classroom and performing home visits with families. During
one such home visit on November 14, 2016, Claimant tripped
over something protruding from the ground as she approached
the house. Claimant fell forward to the ground. Claimant
testified she experienced pain in her neck, left shoulder,
and left knee
2 immediately after
her fall.
3.
Claimant sought medical treatment at Minidoka Medical Center.
Claimant was prescribed a muscle relaxant for her neck spasm.
Claimant soon began complaining of right hand pain as well.
She was referred to Burley orthopedist Gilbert Crane, M.D.,
for her left shoulder, right hand and left knee pain. Dr.
Crane treated those complaints, but did not address
Claimant’s neck problems because he
“[didn’t] do spine[s].” JE G, p. 27. Dr.
Crane’s treatment was considerable, including left
shoulder and right carpal tunnel surgeries, but such
treatment is not germane to this decision, and therefore not
set forth in detail.
[3]
December
Accident
4. On
December 22, 2016, Claimant slipped on ice while at work. At
hearing Claimant testified she landed “on [her]
butt.” Tr. p. 43. In her deposition she claimed she
fell forward during this second accident, landing on
“all fours.” JE T, p. 330. Her first office visit
notes from this accident also mention a fall onto her hands
and knees. All subsequent medical notes describing the
incident indicate Claimant fell onto her hands and knees, or
“all fours.”
5.
After falling on the ice, Claimant presented at Minidoka
Medical Center, complaining of low and upper back pain, and
left ankle pain. While low back pain was mentioned on this
visit, it appears the initial treatment focused on
Claimant’s ankle. At the time she fell in December,
Claimant was still under Dr. Crane’s care for her right
hand and left knee and shoulder complaints, all of which were
still symptomatic.
6. On
her followup visit of December 29, 2016, Claimant did not
mention back pain; instead she focused on her left shoulder,
left ankle, left knee, neck, and right hand. Low back pain
was noted under the heading “Current Problems,”
but not actively examined or treated.
7.
While the office notes of Claimant’s January 12, 2017
visit to the Center again do not mention ongoing low back
complaints, Claimant was referred to Southern Idaho Physical
Therapy for “evaluation of neck, right wrist and hand,
left knee, left ankle, and low back pain.” JE N, p.
250. Notes from the physical therapist do not include any
treatment for low back complaints. Claimant did mention back
pain on a few occasions, such as on January 26, 2017, the day
after she had a shoulder MRI, and on June 22, 2017, when she
stated her bed might be causing her to have a back ache.
8. On
July 21, 2017, Surety sent Claimant to Keith Holley, M.D.,
for an orthopedic IME. At that time Claimant reported central
low back pain without radicular symptoms, but with occasional
tingling in her toes. She also reported tenderness to
palpation at L4 to S1 without paraspinal muscle tenderness.
9. Dr.
Holley diagnosed a myofascial lumbar strain from
Claimant’s November industrial accident. Findings which
were unrelated to either work accident included
Claimant’s lumbar spondylosis and degenerative disc
changes. Dr. Holley felt Claimant’s ongoing low back
symptoms were age related and “primarily due to her
morbid truncal obesity.”
4 JE O, p. 269. He found Claimant was
medically stable from her two industrial accidents.
10.
Subsequently Dr. Crane agreed with Dr. Holley’s
findings in a “check the box” format letter from
Surety.
11.
After the IME report was prepared, Claimant saw Benjamin
Blair, M.D. a Pocatello orthopedic surgeon with OrthoIdaho on
August 15, 2017. On this initial visit, Claimant indicated in
writing that she had injured her neck, left shoulder, left
knee, and right hand in the November accident, and her right
knee, left ankle, and right shoulder in the December
accident. However, she complained of low back pain to Dr.
Blair, which she orally related to her November accident. Dr.
Blair’s notes of that date state that Claimant had no
previous history of low back pain until her November
accident, at which time she noted “sudden
onset…low back pain radiating to the lower
extremity.” JE P, p. 282. Claimant’s December
accident aggravated her ongoing symptoms according to Dr.
Blair’s notes. Dr. Blair felt Claimant was of
“average weight” at 283 pounds with a BMI of
48.6. JE O, p. 283.
12. Dr.
Blair examined Claimant. All mechanical testing was negative.
Claimant walked without abnormal gait. X-rays taken that day
showed disc narrowing at L5-S1 with grade 1 spondylolisthesis
as interpreted by the doctor. MRIs were ordered.
13. Dr.
Blair interpreted the lumbar MRI as showing degenerative disc
disease, central disc bulge with significant disc space...
