While Scripture may say, “Physician, heal thyself” [Luke 4:23, King James Version], that advice should apparently be avoided by professors of rehabilitation counseling. In a case replete with irony, the Court of Appeals of Virginia on Tuesday affirmed a determination by the state’s Workers’ Compensation Commission that neck and left shoulder injuries suffered by a professor in the Department of Rehabilitation Counseling for Virginia Commonwealth University were not compensable consequences of an earlier compensable right shoulder injury [Reid v. Virginia Commonwealth Univ., 2013 Va. App. LEXIS 294 (Oct. 22, 2013)]. Citing decisions quoting Larson’s Workers’ Compensation Law [current § 10.01, et seq.], the court acknowledged that while an employer ordinarily is fully responsible for the natural consequences flowing from a compensable injury, such is not the case if the causal connection is broken. Here the appellate court agreed that the professor’s decision to continue physical therapy, after her treating physician indicated it was no longer necessary, was self-medication and was at her own risk.
On March 23, 2011, the employee dislocated her right shoulder when she tripped while attending a conference in New Orleans. She was treated and released the same day at a medical center in New Orleans. The next day, the employee noticed neck and left shoulder pain that she attributed to overuse from having her right arm in a sling following the accident.
After returning to Richmond, the employee began treatment with the head of the University’s Employee Health Services. The treating physician referred the professor to an orthopedic specialist, who initially prescribed physical therapy. For approximately four weeks, the employee attended physical therapy for her injury. Then she returned to the treating physician, who indicated that she was doing well and had no further need for physical therapy. The treating physician also signed a physical therapy referral form on the day of the visit that further provided “no therapy → This has been D/C’d.”
Professor’s “Professional Knowledge”
Nevertheless, the employee attended a physical therapy session scheduled for the next day, indicating later that she disagreed with the treating physician’s assessment, that she applied her “professional knowledge” to her own case, and that she wanted an additional perspective. At the physical therapy session, the professor worked with the therapist on a home exercise program. During the therapy session, when she attempted some of the exercises utilizing a Thera-Band–a resistive latex exercise band–she “felt a snap in [her] neck accompanied by intense pain, pain on the left side with the inability to turn to the right.”
The professor subsequently filed a claim for benefits claiming that she exacerbated her earlier injuries during her physical therapy session. The deputy commissioner found that the professor’s May 4, 2011 injuries were not compensable consequence injuries because the physical therapy was not necessary medical treatment causally related to the compensable accident. The Commission affirmed, with one commissioner dissenting.
Appellate Court’s Decision
On further appeal, the appellate court affirmed, indicating that the issue was essentially one of causation: whether there was a causal connection between the primary injury and the subsequent occurrence. The court stressed that despite understanding the treating physician’s opinion that she did not require additional physical therapy, the professor attended her May 4, 2011 physical therapy appointment, of her own volition, because she disagreed with the doctor. The commission concluded that because the professor suffered neck and left shoulder injuries during this May 4 appointment, after understanding the therapy had been discontinued, the injuries were not a direct result of the March 23 compensable accident. While there was some conflict in the medical evidence, that was for the Commission to weigh and decide.
The appellate court added that while the professor may have believed that additional physical therapy was required to strengthen her shoulder, without approval from her attending physician, the treatment was not medically necessary, and she underwent such self-remedy at her own risk. The professor’s seeking and performing unauthorized medical treatment constituted a break in the causal relationship between her compensable injury and her subsequent May 4 injuries such that the latter was not a compensable consequence.