Davis v. Edgewood Spring Creek Soda Springs, LLC, 052820 IDWC, IC 2016-020326

Case DateMay 28, 2020
CourtIdaho
SUDI DAVIS, Claimant,
v.
EDGEWOOD SPRING CREEK SODA SPRINGS, LLC, d/b/a EDGEWOOD VISTA, Employer,
and
TRAVELERS PROPERTY & CASUALTY COMPANY OF AMERICA, Surety, Defendants.
Nos. IC 2016-020326, IC 2017-001300
Idaho Workers Compensation
Before the Industrial Commission of the State of Idaho
May 28, 2020
         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 Pocatello, Idaho, on July 8, 2019. Darin Monroe represented Claimant. W. Scott Wigle represented Defendants. The parties produced oral and documentary evidence at hearing and submitted post-hearing briefs. Three post-hearing depositions were taken. The matter came under advisement on April 5, 2020.          ISSUES          The parties agreed to the following issues for this bifurcated adjudication:          1. Whether the condition for which Claimant seeks benefits was caused by the industrial accidents; and          2. Whether and to what extent Claimant is entitled to the following benefits:
a. Medical Care;
b. Temporary partial and/or temporary total disability (TPD/TTD); and
c. Attorney Fees.
         All other issues are reserved.          CONTENTIONS OF THE PARTIES          Claimant asserts she injured her low back to the point where surgery was required as the result of two industrial accidents which occurred in July 2016. She is entitled to medical care and temporary disability benefits associated with the surgery and related care. She also is entitled to attorney fees based on Defendants’ unreasonable denial of such benefits.          Defendants argue that Claimant may have temporarily aggravated her lumbar spine in the industrial accidents, but her need for surgery was due to the natural progression of her longstanding degenerative low back condition and prior fusion surgery at the level just below her most recent surgery. In fact, Claimant’s low back became symptomatic shortly before her industrial accidents. Defendants are not liable for any of the medical expenses or benefits claimed in this matter and attorney fees are unwarranted.          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 N admitted at hearing; and
3. The post-hearing deposition transcripts of Nita Weber, D.O., James Bates, M.D., and Lynn Stromberg, M.D., taken on September 12, September 24, and December 17, 2019, respectively.
         FINDINGS OF FACT          1. At the time of hearing Claimant was a 57-year-old woman living in Soda Springs, Idaho. She had worked for Employer for several years in nursing and supervisory capacities.          PRE-EXISTING LOW BACK HISTORY          2. In or around 1999, Claimant underwent lumbar spine surgery which fused the vertebrae at L5-S1. Claimant had no appreciable residual low back issues after this surgery until 2016. Exactly when in 2016 Claimant’s lower back became symptomatic is a key dispute in this case and will be discussed in greater detail hereinafter.          INDUSTRIAL ACCIDENTS          3. On July 12, 2016, Claimant was assisting a resident from a toilet to her wheelchair. As Claimant pivoted to set the patient in the chair Claimant felt a sudden onset of excruciating pain in her low back and right thigh. Claimant testified she had not experienced that type of pain at any point prior.          4. Claimant did not seek medical treatment after this event. She left work early and stayed home for the next couple of days. Her initial pain lessened over time with ice and anti-inflammatories. Claimant assumed she has strained her low back.          5. Claimant avoided heavy lifting when she returned to work but was able to do her regular duties as the director of nursing services.          6. On July 25, 2016, Claimant was lifting a piano bench at work. As she did so she felt immediate pain in her right thigh and low back. The pain was so severe she fell to the ground and could not get up by herself. Two co-workers assisted her into a standing position and helped her to her office. Claimant sought immediate medical care with her regular physician, Nita Weber, D.O.          OVERVIEW OF MEDICAL TREATMENT FROM JULY 2016 FORWARD1          7. Upon examination Dr. Weber recommended Claimant see a neurosurgeon. In August 2016 Claimant was evaluated at the Utah Spine, Sport & Rehab facilities in Ogden, Utah. In mid-September 2016 Claimant underwent a spinal MRI2 which read to include a broad-based disc bulge at L4-5 with moderate to severe foraminal stenosis right greater than left. Claimant’s symptoms were increasing during this time frame. Electrodiagnostic studies performed that same month revealed evidence of mild right sided L5 acute lumbosacral radiculopathy with a loss of reflexes at Claimant’s right knee and bilateral ankles. Surgical consultation was arranged with Dennis Winters, M.D., a spinal surgeon.          8. Dr. Winters ordered a third MRI in early October 2016, which showed postoperative changes (from 1999 surgery) at L5-S1, and a suspected focal disc protrusion/herniation at L4-L5. Based on Claimant’s increasing symptoms and the MRI findings Dr. Winters recommended a micro-discectomy at L4-5.          9. After learning of Dr. Winters’ recommendation, Defendants sent Claimant for an independent medical examination with Lynn Stromberg, M.D., a spinal surgeon in Idaho. Dr. Stromberg believed Claimant would benefit from spinal surgery but disagreed that a micro-discectomy was the proper procedure. Instead, Dr. Stromberg felt Claimant needed a fusion surgery. However, Dr. Stromberg felt Claimant’s need for surgery was unrelated to her industrial accidents of July 2016.          10. Claimant sought out another surgical opinion, this time from Clark Allen, M.D., an Idaho Falls neurosurgeon. After his evaluation Dr. Allen opined that Claimant needed a full decompression and fusion surgery at L4-5. Defendants refused to pay for the proposed surgery.          11. On November 14, 2016, Dr. Allen performed a bilateral discectomy and fusion surgery at L4-5. At surgery, Dr. Allen noted Claimant’s exiting L4-5 nerve roots were severely compressed, right greater than left. He also noted scarring from the adjacent previously fused level which contributed to Claimant’s L4-5 segment narrowing.          12. Claimant had a good result from the surgery, and after a period of recovery was released from care by Dr. Allen on January 26, 2017. Thereafter Claimant returned to work for a new employer.          DISCUSSION AND FURTHER FINDINGS          13. Claimant has the burden of proving the condition for which compensation is sought is causally related to an industrial accident. Callantine v Blue Ribbon Supply, 103 Idaho 734, 653 P.2d 455 (1982). The proof required is “a reasonable degree of medical probability.” Anderson v. Harper's Inc., 143 Idaho 193, 196, 141 P.3d 1062, 1065 (2006). Claimant is required to establish a probable, not merely a possible, connection between cause and effect to support her contention. Dean v. Dravo Corporation, 95 Idaho 558, 560-61, 511 P.2d 1334, 1336-37 (1973). In other words, Claimant must show there is more evidence for causation than against. Fisher v. Bunker Hill Co., 96 Idaho 341, 528 P.2d 903 (1974). In determining causation, it is the role of the Commission to determine the weight and credibility of testimony and to resolve conflicting interpretations of testimony.          14. The fact that Claimant suffered a covered injury to a particular part of her body does not make Defendants liable for all future medical care to that part of her body, even if the medical care is reasonable. Henderson v. McCain Foods, Inc., 142 Idaho 559, 563, 130 P.3d 1097, 1101 (2006). In the present case, it is undisputed that Claimant injured her low back in July 2016 in one or more industrial accidents. The debate is over whether one or more of these work accidents necessitated or contributed to the need for Claimant’s November 14, 2016, back surgery.          Medical Record Dispute          15. Defendants’ position centers in large part on a medical records trail which began shortly before Claimant’s industrial accidents. Defendants argue the records establish...

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