In re Claim of Tomsha, 031821 COWC, 5-088-642-002

Docket NºW.C. 5-088-642-002
Case DateMarch 18, 2021
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...

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