IN THE MATTER OF THE CLAIM OF: YVONNE TOMSHA, Claimant,
v.
CATHOLIC HEALTH INITIATIVES d/b/a PENROSE/ST FRANCIS, Employer,
and
ACE AMERICAN INSURANCE, Insurer, Respondents.
W.C. No. 5-088-642-002
Colorado Workers Compensation
Industrial Claim Appeals Office
March 18, 2021
HEUSER
& HEUSER LLP, Attn: GORDON J HEUSER ESQ, (For Claimant)
POLLART MILLER LLC, Attn: JESSICA L GRIMES ESQ, (For
Respondents)
FINAL ORDER
The
respondents seek review of an order of Administrative Law
Judge Lamphere (ALJ) dated November 18, 2020, that determined
they did not overcome the opinion of the Division-sponsored
independent medical examination (DIME) physician on maximum
medical improvement (MMI) and ordered them to pay for the
block(s) recommended by the DIME physician necessary to
complete his DIME review. We affirm.
After a
hearing, the ALJ made findings and conclusions that are
summarized below.
The
claimant sustained an admitted injury to her left shoulder
and cervical spine on March 1, 2018, when she pulled a
patient in a wheelchair through a doorway. While holding the
door open with her right arm, the claimant felt a pull in her
left shoulder and posterior shoulder girdle region
posteriorly.
The
claimant sought treatment at Centura Centers of Occupational
Medicine (CCOM), where she saw Steven Byrne, PA-C (Byrne).
Byrne noted that the claimant was experiencing joint pain and
stiffness in her left shoulder and diagnosed her with a
muscle and tendon strain in her left rotator cuff consistent
with the work injury. He gave work restrictions to include no
lifting, pushing, or pulling greater than 20 pounds. X-rays
of the claimant’s left shoulder and cervical spine
revealed mild-moderate acromioclavicular joint osteoarthritis
in her left shoulder, cervical spondylosis, and facet
arthropathy.
After
the claimant experienced a decrease in her range of motion
and an increase in the pins and needles in her left arm,
Byrne referred her to Dr. Abercrombie. The claimant
subsequently started chiropractic care under Dr. Abercrombie
at Alliance Health Partners. The claimant was experiencing
constant left shoulder, lower back, and upper back pain. She
also was complaining of left upper extremity paresthesia
affecting the second and third digits. According to Dr.
Abercrombie’s note, the claimant’s symptoms
increased with placing her purse strap on the left shoulder,
computer typing, pushing and pulling movements, as well as
lifting and reaching. The claimant received chiropractic care
through April 14, 2018, at which time she still was
experiencing some upper back ache/tightness and left-hand
paresthesia.
The
claimant then saw Dr. Neubauer at CCOM after experiencing
tingling in her left shoulder and arm. Dr. Neubauer noted
that the claimant continues to experience pain with motion in
her left shoulder, as well as tingling, which had begun to
extend into her middle, fourth, and fifth fingers. The
claimant underwent an MRI which revealed AC joint arthropathy
with a small amount of subacromial bursal fluid with no
rotator cuff atrophy or neuromuscular edema. The radiologist
also reported that the findings were suggestive of a superior
labral tear with propagation to the posterosuperior quadrant.
Dr. Neubauer subsequently gave the claimant a steroid
injection in her left shoulder which gave her significant
relief.
On May
7, 2018, Dr. Leppard performed an EMG which revealed
abnormalities to include a mild left median mononeuropathy at
the wrist and left ulnar mononeuropathy at the elbow. She
instructed the claimant to follow up with Byrne and return as
needed.
The
claimant saw Dr. Walden for an orthopedic consult. Dr. Walden
reported that he was unsure whether the SLAP tear in the
claimant’s left shoulder was contributing to her pain,
but that she did have rotator cuff tendinitis and an
acromioclavicular joint injury. He recommended physical
therapy and that the claimant consider further chiropractic
treatment. Dr. Walden performed a half injection at the
subacromial space and obtained X-rays of the claimant’s
left shoulder. Dr. Walden reported that the X-rays did not
demonstrate fractures or dislocations.
The
claimant subsequently underwent physical therapy two times
per week for 4 weeks. She continued to attend physical
therapy until August 16, 2018, at which time she was
discharged to a home exercise program.
The
claimant reported increased pain in her shoulder to Dr.
Walden, who performed a steroid injection. However, due to
continuing shoulder pain, Dr. Walden recommended that a
subacromial decompression and SLAP repair or biceps tenodesis
be completed. The claimant subsequently underwent a
subacromial decompression and bicep tenodesis with Dr.
Walden. Thereafter, on January 30, 2019, Dr. Walden performed
a left shoulder manipulation to relieve the claimant’s
left shoulder adhesive capsulitis.
Physical
therapy notes from February 25 through March 25, 2019,
reflect that the claimant was having significant neurogenic
symptoms in her left arm and hand which the physical
therapist indicated may be due to a plexopathy or brachial
injury.
The
claimant followed up with Dr. Walden. She reported that she
had stopped making much progress with physical therapy. He
recommended another arthroscopic evaluation with debridement,
and shoulder manipulation. Dr. Walden performed a left
shoulder arthroscopic debridement, capsular release, and left
shoulder manipulation under anesthesia. After the shoulder
surgery, the claimant underwent a course of physical therapy.
However, the physical therapy records revealed that the
claimant was consistently experiencing pain, numbness,
tingling, and weakness in the left upper extremity. They also
showed that the claimant was experiencing pain and stiffness
in her cervical spine, thoracic spine, scapula, upper
trapezius, pectoralis minor as well as in the shoulder down
the left arm. These same records show that throughout the
course of physical therapy, care was directed to the entire
left extremity to include the scapula, pectoralis minor, the
trapezius, and left arm. Dr. Walden’s records of August
6 and September 17, 2019, indicated that the claimant still
was having pain in the left shoulder with numbness and
tingling.
The
claimant was placed at MMI by Dr. Centi on October 16, 2019.
Dr. Centi assigned a 15% upper extremity impairment, which
converts into a 9% whole person impairment. Dr. Centi
assigned the claimant work restrictions of no lifting,
carrying, pushing, or pulling over 20 pounds with the left
arm and no overhead lifting with the left arm.
On
February 4, 2020, the claimant underwent a DIME with Dr.
Hall. The claimant was experiencing pain in the neck,
shoulder, arm, and periscapular area. She also was
experiencing daily upper quadrant symptoms of constant pins
and needles in her left hand, arm, and around her left
shoulder. The claimant described the pain as burning, deep
aching, and occasionally stabbing which will involve her
hands, triceps, anterior chest wall, and periscapular area.
According to...
