In re Claim of Singh, 060421 COWC, 5-101-459-005

Docket NºW.C. 5-101-459-005
Case DateJune 04, 2021
PINNACOL ASSURANCE, Insurer, Respondents.
W.C. No. 5-101-459-005
Colorado Workers Compensation
Industrial Claim Appeals Office
June 4, 2021
          RUEGSEGGER SIMONS & STERN LLC, Attn: THOMAS M STERN, (For Respondents)          FINAL ORDER          The self-represented (pro se) claimant seeks review of an order of Administrative Law Judge Kabler (ALJ) dated December 8, 2020, that determined the following: (1) the respondents overcame the opinion of the Division-sponsored independent medical examination (DIME) physician on mental impairment; (2) the respondents overcame the opinion of the DIME physician on permanent impairment of the cervical spine; (3) the claimant failed to overcome the opinion of the DIME physician on maximum medical improvement (MMI); (4) the claimant failed to overcome the opinion of the DIME physician on no permanent impairment for the lumbar and thoracic spine; (5) the claimant is not entitled to temporary total disability (TTD) benefits after November 15, 2019; (6) the claimant failed to establish he is entitled to permanent total disability (PTD) benefits (7) the claimant failed to establish he is entitled to a general award of medical benefits; and 8 the claimant failed to establish he is entitled to post-MMI maintenance medical benefits (Grover medical benefits). We affirm.          The claimant worked as a taxi driver for the respondent employer. On March 3, 2019, the claimant was involved in a work-related motor vehicle accident while driving a taxi for the employer. The claimant was transported from the scene of the accident by ambulance to Rose Medical Center Emergency Department where he was examined by Dr. Moon. The claimant complained of left sided neck pain that was non-radiating. Dr. Moon found left lateral paracervical neck tenderness. He specifically noted no midline vertebral tenderness and no tenderness in the cervical, thoracic or lumbar spine. Dr. Moon’s clinical impression was neck muscle strain. His records indicate no neurological deficits and no other signs of serious injury. Dr. Moon prescribed medication and discharged the claimant home.          The claimant chose Rocky Mountain Medical Group (RMMG) as his authorized treating provider (ATP) and began treating on March 6, 2019, with Dr. Ramaswamy. The claimant reported a dull pain in his chest, headaches, and hearing a clicking sound when lifting his head while lying down. The claimant also reported neck pain, upper back pain, “electrical shocks” radiating from his neck to head, and mild lower back pain. The claimant reported he had pre-existing neck pain, and that a cervical fusion was recommended at some point. Dr. Ramaswamy noted tenderness in the cervical spine and mild tenderness in the thoracic spine with mild trigger point activity. He diagnosed the claimant with a contusion of unspecified front wall of thorax, strain of muscle, fascia, and tendon at neck level, and strain of muscle and tendon of the wall of the thorax.          The claimant returned to Dr. Ramaswamy on March 20, 2019, reporting numbness in his left hand, occasional dizziness, nausea, and headaches, in addition to lower back and neck pain. On examination, Dr. Ramaswamy noted tenderness in the left trapezius with trigger point activity, tenderness in the cervical spine, and tenderness in the lumbar spine. Dr. Ramaswamy placed the claimant at modified duty and recommended he not drive a taxi cab.          The respondents filed a general admission of liability (GAL), admitting for TTD benefits beginning on March 4, 2019.          On April 10, 2019, five weeks from the date of his accident, the claimant again saw Dr. Ramaswamy, reporting that he was worsening, although he also reported being 10%-20% better. The claimant again reported neck pain, lower back pain, left hand numbness and tingling, and right chest wall pain. The claimant also reported shortness of breath due to pain and reported he was unable to work in any capacity. Dr. Ramaswamy noted that the claimant “is set up for delayed recovery based on his past history” (10 year recovery from prior motor vehicle accident). Dr. Ramaswamy stated there was a significant history of chronic pre-existing pain with prior lumbar and cervical pathology. He recommended a cervical MRI based on the claimant’s complaints of neck pain and left hand numbness, which the claimant characterized as new since the March 3, 2019, accident.          The claimant previously was involved in a motor vehicle accident on December 11, 2007, while driving a taxi. The claimant’s ATP at that time diagnosed the claimant with traumatic headaches, chest wall rib sprain/strain, traumatic vertigo, bilateral hand and forearm abrasions, chronic cervical and thoracic sprain/strain with spasms, lumbar sprain/strain with spasm, cervical disc derangement, insomnia, anxiety, depression, and esophageal discomfort with spasm. On December 22, 2008, the claimant’s ATP opined that the claimant had a 1% whole person impairment rating for chronic pain, and released the claimant from care at MMI.          For many years after being placed at MMI for his 2007 work injury, the claimant continued to receive medical treatment. On January 8, 2019, the claimant saw his ATP for a follow up appointment where the claimant complained of neck pain. His ATP noted he had discussed with the claimant a C4-5 and C5-6 ACDF procedure.          On April 20, 2019, the claimant underwent an MRI for his March 3, 2019, work injury as recommended by Dr. Ramaswamy. When compared to his prior MRI of December 8, 2018, it showed a new C5-6 left paracentral disc extrusion and possible free disc fragment with mild indentation of the left side of the cord.          The claimant returned to Dr. Ramaswamy on May 9, 2019. At that time, the claimant reported his condition was worsening. Dr. Ramaswamy opined that the claimant was presenting with diffuse pain and quite a bit of symptomatology with some somatic complaints. He believed pain behavior was present. While Dr. Ramaswamy noted that the cervical spine MRI revealed a new disc protrusion at the left C5-6 interspace, he also noted that some of the claimant’s subjective complaints outweighed objective findings. Dr. Ramaswamy referred the claimant to Dr. Lesnak for a physiatry consult.          On examination, Dr. Lesnak noted that the claimant provided submaximal effort during his evaluation and frequently limited his activities because of pain/fear of pain. Dr. Lesnak noted that “it seems quite clear that there is a significant amount of psychosocial factors that are currently affecting his symptoms, his recovery, as well as his overall presentation and perceived functional status.” Dr. Lesnak opined that “there is a likely presence of an underlying symptom somatic disorder/somatoform disorder” and noted that the claimant exhibited a significant amount of anxiety.          The claimant subsequently returned to Dr. Ramaswamy. The claimant reported no change in his condition, with ongoing neck and lower back pain, left lower extremity numbness and tingling, left arm numbness and tingling, and right leg pain. He also reported dizziness, chest wall discomfort, and shortness of breath. The claimant reported he was 30% worse concerning neck pain, lower back pain, and left arm and leg symptoms. Dr. Ramaswamy referred the claimant for a psychological consult with Dr. Reilly, noting that the claimant had a history of anxiety and had stated that if he stopped his medication, he would be in the emergency room. Dr. Ramaswamy noted that “[s]trains typically resolve by now and [the claimant] is presented with delayed recovery.”          Dr. Reilly performed neuro-psychometric testing and conducted a clinical interview. He opined that the claimant’s neuro-psychometric testing results could not be considered valid because of symptom magnification, exaggerated symptoms reporting, and negative response bias. Dr. Reilly concluded that the claimant’s “clinical presentation is strongly suggestive of a somatic symptoms disorder/chronic pain condition.” He diagnosed the claimant with somatic symptom disorder with predominant pain.          Dr. Lesnak performed EMG testing which did not show any evidence of pathology. Dr. Lesnak did not recommend any further diagnostic or interventional treatments and indicated the claimant was medically safe to return to work as a cab driver without restrictions.          The claimant saw Dr. Ramaswamy on June 25, 2019, and reported he was no better and he was disabled. Dr. Ramaswamy noted that the MRI showed a...

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