Jeffrey Houle
v.
Verizon Communications Inc.
Opinion No. 02-20WC
Vermont Workers Compensation Decisions
State of Vermont Department of Labor
December 6, 2019
Hearing held in Montpelier on November 4, 2019
State
File No. R-117
Mark
H. Kolter, Esq., for Claimant.
Keith
J. Kasper, Esq., for Defendant.
Beth
A. DeBernardi, Administrative Law Judge.
OPINION
AND ORDER
Michael A. Harrington, Interim Commissioner.
ISSUE
PRESENTED:
Does
Claimant’s current regimen of prescription opioid
medications constitute reasonable medical treatment for his
June 27, 2000 compensable work injury?
EXHIBITS:
Joint
Exhibit I: Medical records
Claimant’s
Exhibit 2: Curriculum Vitae of Anne
Vitaletti-Coughlin, MD
Claimant’s
Exhibit 3: McGill Pain Index graphs
Claimant’s
Exhibit 4: Agreement for Permanent Total Disability
Compensation (Form 22) dated May 2, 2004 with cover letter
dated July 19, 2006
Claimant’s
Exhibit 5: Vermont Department of Health Rule Governing the
Prescribing of Opioids for Pain, effective July 1, 2017
Claimant’s
Exhibit 9: July 25, 2019 Vermont Prescription Monitoring
Program Prescriber Report for Dr. Vitaletti-Coughlin
Claimant’s
Exhibit 11: Complex Regional Pain Syndrome Fact Sheet
published by the National Institute of Neurological Disorders
and Stroke
Claimant’s
Exhibit 12: October 30, 2017 letter from Philip Kiely, MD
Defendant’s
Exhibit A: Curriculum Vitae of Verne Backus, MD
CLAIM:
Medical
benefits pursuant to 21 V.S.A. § 640(a)
Costs
and attorney fees pursuant to 21 V.S.A. § 678
FINDINGS
OF FACT:
1. At
all times relevant to these proceedings, Claimant was an
employee and Defendant was his employer as those terms are
defined in the Vermont Workers’ Compensation Act.
2. I
take judicial notice of all forms and correspondence in the
Department’s file relating to this claim.
Claimant’s
June 2000 Work Injury and Diagnosis
3.
Claimant is a 53-year-old man who lives in Hyde Park,
Vermont. He worked for Defendant as a lineman for three
years.
4. On
June 27, 2000, Claimant was working with a co-employee in
East Calais. He was on the ground, and his partner was up in
the bucket truck working on overhead telephone lines. A piece
of overhead equipment fell and struck Claimant’s right
shoulder, knocking him to the ground. He sustained a right
shoulder injury in the accident.
5. In
December 2000 Claimant was diagnosed with complex regional
pain syndrome (CRPS) in his right upper extremity. CRPS is a
serious neurologic derangement characterized by severe pain,
sensory and motor dysfunction, and autonomic dysfunction.
Defendant does not dispute Claimant’s CRPS diagnosis.
Claimant’s
Claim for Benefits
6.
Claimant has not worked since June 27, 2000. Defendant
accepted his injury as compensable and began paying
workers’ compensation benefits accordingly.
7. In
November 2002 Claimant underwent a functional capacity
evaluation at Fletcher Allen Health Care that concluded he
had no capacity to sustain work activities on an
uninterrupted basis. Joint Exhibit I, at 129-33. In
December 2002 physiatrist Mark Bucksbaum, MD, performed an
independent medical examination of Claimant at his request.
Joint Exhibit I, at 153-94. Dr. Bucksbaum found that
Claimant had reached an end medical result for his
work-related injury and that he was permanently and totally
disabled. Id. at 193.
8. In
April 2004 the parties agreed that Claimant was permanently
and totally disabled, and they entered into an Agreement for
Permanent Total Disability Benefits (Form 22) in May.
Claimant’s Exhibit 4.
9. With
the Department’s approval, Defendant discontinued
Claimant’s temporary total disability benefits and
began paying permanent total disability benefits. Defendant
also pays for Claimant’s medical treatment, including
his opioid medications.
10. In
September 2018 Defendant filed a Notice of Intention to
Discontinue Payments (Form 27) related to Claimant’s
opioid medications. The Department approved the
discontinuance, and Claimant filed a Notice and Application
for Hearing (Form 6). Defendant continues to pay for the
medications pending the resolution of this issue.
Claimant’s
Severe Pain and Subsequent Medical Course
(a)
Claimant’s Severe Pain
11.
Claimant suffers from prolonged, severe pain in his right
upper extremity associated with CRPS. His treating
anesthesiologist, Anne Vitaletti-Coughlin, MD, repeatedly
described his CRPS as severe and refractory, meaning
resistant to treatment. She identified his CRPS symptoms as
including unrelenting intense burning pain and extreme skin
sensitivity. Dr. Vitaletti-Coughlin credibly testified that
CRPS is the most painful condition she has treated in her
25-year career and that Claimant’s CRPS is among the
worst she has seen.
12.
Claimant described three types of pain that he experiences
daily. First, his skin surface hurts like a severe sunburn.
Showering, wearing certain clothes and sleeping on some
bedsheets all increase this pain. Second, he has a constant
tingling pain in his right upper extremity. Third, he
experiences “bone pain” that feels like his arm
is being broken; he described this pain as the worst of all.
Claimant also has frequent headaches from the back of his
head to his right eye that are sensitive to light and noise.
He credibly described his pain condition as
“consuming,” explaining that “it eats you
up totally.”
13.
Claimant’s chronic pain causes other symptoms in turn,
including a serious sleep disturbance, depression, and
trouble with memory and focus. At times, he has also
experienced suicidal ideation.
(b)
Claimant’s Medical Course
14. In
June 2000 Claimant’s shoulder injury was treated with
hydrocodone and physical therapy. In October 2000 he
underwent surgery. In December 2000 he was diagnosed with
CRPS and began treating with...
