Arkansas Muscle Strain Claim May Be Compensable Where Physician Did Not Observe Spasms
Construing Ark. Code Ann. § 11-9-102(4)(D) (Supp. 2019), which indicates that a compensable injury must be established by medical evidence supported by objective findings [emphasis mine], an Arkansas appellate court reversed a decision by the state’s Workers’ Compensation Commission that denied benefits for a claimed injury to an employee’s right buttock and thigh, based upon its finding that none of the physicians that examined the claimant had observed a muscle spasm [Melius v. Chapel Ridge Nursing Ctr., LLC, 2021 Ark. App. 61, 2021 Ark. App. LEXIS 67 (Feb. 10, 2021)]. While the court agreed that the presence of observed muscle spasms supplied the necessary “objective” evidence to support a claim, the Court stressed that it was error to require such a medical observation. Here, the diagnosis of muscle strain, along with prescribed treatment of medications, physical therapy, and pain management was sufficient to establish objective findings.
Background
In July 2018, the claimant, who worked as a treatment nurse, reported an on-the-job injury to her right thigh and buttock that occurred after helping lift a patient who was being transferred to the emergency room. Claimant was seen that day by Dr. Keith Holder. Claimant complained of a sharp, shooting pain in her right gluteal area. Dr. Holder’s examination notes indicated that the claimant had pain to palpitation over the piriformis in her right hip. Dr. Holder diagnosed Melius with a strain of muscle, fascia, and tendon of right hip. She continued to see Dr. Holder on multiple occasions thereafter. She was also examined another physician. She received one or more steroid shots, muscle relaxer medications and other medicine to assist with her pain level.
ALJ’s and Commission’s Decisions
Following a hearing, the ALJ denied benefits, finding that the claimant had failed to prove by a preponderance of evidence that she sustained a compensable injury and failed to provide evidence in the form of objective medical findings to support her contention that she suffered spasms related to the July 2018 injury. The ALJ stated,
She stated she had pain and spasms 1-4 times per day. The medical evidence, however, does not support her contentions. She was treated by several physicians, none of whom found evidence of spasms or made any notations for objective findings of spasms [Opinion p. 4].
Furthermore, the ALJ did not find the claimant’s testimony credible. The Commission affirmed and adopted the ALJ’s opinion.
Appellate Court’s Decision
The appellate court acknowledged that pursuant to Ark. Code Ann. § 11-9-102(4)(D) (Supp. 2019), a compensable injury must be established by medical evidence supported by objective findings. “Objective findings,” noted the court, are those findings that cannot come under the voluntary control of the patient. Specifically, indicated the court, complaints of pain were not considered to be objective medical findings.
The court also acknowledged that the ALJ had found the claimant’s testimony was not credible in light of the balance of the evidence presented. The appellate court could not and would not second-guess that determination.
Objective Findings
The court noted that the claimant had been diagnosed with a strain of muscle, fascia, and tendon of right hip, that she had received medication, and that she subsequently was referred to physical therapy and a pain specialist for relief. What was disputed was whether the claimant presented proof of objective medical evidence and whether the injury was work related. Noting precedent from the state supreme court, the appellate court indicated that it agreed with the claimant’s argument that her diagnosis of muscle strain along with prescribed treatment of medications, physical therapy, and pain management was sufficient to establish objective findings.
Construing the holding in Fred's, Inc. v. Jefferson, 361 Ark. 258, 206 S.W.3d 238 (2005), the appellate court stressed that there was no requirement under Arkansas law that a doctor, physical therapist, or other medical provider actually observe a patient having a muscle spasm before an employee’s injury could be compensable. The court held that a reasonable inference from the chronology of events was that the medications, physical therapy, and pain management were prescribed to aid the claimant and to treat her injury, and there was no evidence introduced to the contrary. Any other construction of the events did not withstand scrutiny or pass the test of reasonableness, said the court. Accordingly, the matter was remanded for further determinations of whether the claimant suffered a compensable July 2018 injury to her buttock and thigh, whether she was entitled to medical treatment, and whether she was entitled to temporary partial-disability benefits.