Lead Opinion
Gladis Hernandez appeals the denial of her workers’ compensation claim for benefits
Substantial evidence exists only if reasonable minds could have reached the same conclusion without resort to speculation or conjecture. White Consol. Indus. v. Galloway,
It is within the Commission’s province to reconcile conflicting evidence, including the medical evidence, and to determine the true facts. Stone v. Dollar Gen. Stores,
Hernandez relies upon Dr. Raben’s opinion that her compensable injury caused her lumbar disc herniation and associated treatment. This differed from the opinion of Dr. Gary Moffitt, Wal-Mart’s company doctor and a general practitioner. Dr. Moffitt stated that Hernandez’s complaints of left-side pain after her compensable injury did not correlate with an MRI performed on September 1, 2005, which disclosed a herniated disc at the same level on the right side. Dr. Moffitt opined that the herniation was unrelated to her com-pensable injury, which he diagnosed as a muscular strain. On January 13, 2006, Dr. Moffitt saw Hernandez and reported that her symptoms and complaints of pain were “consistent with an L5-S1 radiculopathy
In making its findings, the Commission found that Dr. Raben’s opinion was entitled to minimal weight. The Commission noted that Dr. Konstantin V. Berestnev saw Hernandez on August 15, 2005, ahd assessed a lumbar strain, as had Dr. Mof-fitt. It pointed to a report by Dr. Moffitt that the injury had largely resolved by November 1, 2005. The Commission |,, no ted that orthopedic surgeon Dr. Robert Tomlinson did not “opine that the L5-S1 disc protrusion was the result of an accidental injury,” that neuro-surgeon Dr. Kelly Danks did not opine that the “degenerative bulging was the result of an acute injury,” and that Dr. Danks did not causally connect his recommendation for epidural injections to Hernandez’s compensable injury. The Commission observed, “None of the claimant’s treating physicians, other than Dr. Raben, opined that the claimant had sustained a herniated disc as a result of her lumbar strain.”
It was up to the Commission, as the finder of fact, to resolve conflicting medical opinions and evidence regarding the causation of Hernandez’s disc herniation. The evidence, viewed in the light most favorable to the Commission’s findings, is such that reasonable minds could have reached the conclusion of the Commission without resort to speculation or conjecture. See White Consol. Indus. v. Galloway,
Affirmed.
Concurrence Opinion
concurring.
U write separately not merely to refute the opinions of the dissenting judges, but also to. state my disappointment and frustration with the majority’s refusal to enunciate a clear standard to be used in determining whether evidence presented to the Commission has been “arbitrarily disregarded.” The doctrine relating to arbitrary disregard of evidence began in Arkansas in the context of railroad cases, where juries engaged in speculation to find negligence in the face of uncontradicted eyewitness testimony by railroad employees describing the circumstances of the accident. The Arkansas Supreme Court held that juries were not permitted , to grant verdicts for a plaintiff — the party with the burden of proof — in the face of uncontradicted eyewitness evidence to the contrary. See generally Landis v. Hastings,
That doctrine has been turned on its head in workers’ compensation cases
|7What must be shown to demonstrate that the Commission has arbitrarily disregarded evidence? In the context of appellate review of administrative decisions in general, our supreme court has held that, in order for an administrative action to be invalid as arbitrary, the action must either lack any rational basis or hinge on a finding of fact based on an erroneous view of the law. Pine Bluff for Safe Disposal v. Arkansas Pollution Control and Ecology Commission,
The dissenting judges and, it appears, the majority, reject my assertion that the above-cited cases defining arbitrariness in administrative cases are applicable to our
The answer to the argument raised by appellant in this case is that we are unconcerned with the weight of the opposing testimony. We ignore it in our review. See Barksdale Lumber Co. v. McAnally,
Because there is no agreement on this court regarding the proper standard of review in workers’ compensation cases, our application of it differs widely from opinion to opinion. I hope that the supreme court will address the problem and issue specific guidelines appropriate to examining appeals for sufficiency in general and arbitrary disregard of evidence in particular that can be evenly applied.
I respectfully concur.
Notes
. An excellent example of this phenomenon is found in Judge Robbins’s dissent, where he says that "if the claimant's disability arises soon after the accident and is logically attributable to it, with nothing to suggest any other explanation for the employee's condition, we may say without hesitation that there is no substantial evidence to sustain the Commission’s refusal to make an award.” Thus, in Judge Robbins’s view, the claimant's burden of proof is discharged by a presumption of compensability despite the General Assembly’s dictate that, in determining whether a party has met the burden of proof on an issue, the Commission must weigh the evidence impartially, without giving the benefit of the doubt to any party. Ark.Code Ann. § 11 — 9— 704(c)(4) (Repl.2002). Judge Robbins relies on Heptinstall v. Asplundh Tree Expert Co.,
. Judge Baker's continued insistence that I have given no examples of our misapplication of the doctrine of "arbitrary disregard” of evidence puzzles me. See also note 1 supra and note 4 infra. Most of the more egregious misapplications of the doctrine are found in unpublished opinions that I am precluded by Arkansas Supreme Court Rule 5-2 from citing. However, these cases exist, and interested researchers are invited to read them and draw their own conclusions.
. In her dissent, Judge Baker states that my discussion of the law relating to the arbitrary disregard of evidence in workers’ compensation cases has no place in the analysis of this case. However, appellant repeatedly asserts that the Commission arbitrarily disregarded the testimony of Dr. Raben in finding that appellant sustained only a lumbar strain rather than a herniated disc as a result of her compensable injury, and therefore erred in denying additional medical benefits, temporary-total-disability benefits, and attorney's fees. Plainly, a discussion of these issues is essential to a decision of the issues before us.
. These rules have at times been ignored or grossly misapplied by the appellate court. One example is the case of Bohannon v. Wal-mart Stores, Inc.,
finding that contrary evidence was arbitrarily disregarded. To ignore the established standard of review in order to apply, when we see fit, a different standard that has been expressly rejected by the supreme court is truly arbitrary.
In her dissent in the instant case, Judge Baker waxes eloquent about the need for each party and entity involved in workers’ compensation appeals to dutifully perform their assigned function, and then states that she would reverse on the basis of an argument never made by the claimant, below or on appeal. We are, of course, prohibited from reversing on such grounds. See Hill v. White-Rodgers,
. Despite a diligent search, I have been unable to find a single workers’ compensation case in which we have held that evidence favorable to an employer or insurer was arbitrarily disregarded.
Dissenting Opinion
dissenting.
| nit is not disputed that appellant suffered a lumbar strain during the subject incident on August 11, 2005, but the issue is whether that lifting incident at woi’k also caused her herniated disc. Appellant’s herniated disc became symptomatic within five weeks after the incident. By September 19, Dr. Moffitt reported that appellant had been having “intermittent numbness of her entire right leg but was not having much in the way of symptoms on her left side.” His September 30, November 1, and January 13 reports all mention right-leg or foot numbness or pain.
The majority opinion states expressly what the Commission held by implication, i.e., that it was Dr. Moffitt’s opinion that appellant’s herniated disc was not related to her injury she suffered at work. I have scoured the medical reports made by Dr. Moffitt and do not find such an opinion. The nearest Dr. Moffitt comes to actually giving an opinion on the lack of a causal connection between the August 11 incident and appellant’s herniated disc is contained in his letter of October 21, 2005, where he states:
In regards to the injury reported on the 11th of August, it really appears to methat this is mostly an SI strain on the left side. She does have evidence of a disc protrusion on the right, but it does not correlate with her symptoms and physical findings.
Whatever is meant by recognizing that appellant has evidence of a disc protrusion (which an MRI performed following the August 11 incident documented), and then saying it does not correlate with her symptoms and physical findings is unclear, especially in light of Dr. Moffitt’s letters of September 19 and September 30 where he reported appellant’s complaints of numbness in her right leg.
1 iaTwo points should be noted with respect to Dr. Moffitt’s October 21 letter: first, he does not rule out the possibility that appellant suffered injury beyond a lumbar strain because he states that it appears to him that this was “mostly” an SI strain on the left. Secondly, Dr. Mof-fitt did not represent that what “appears” “mostly” to him was an opinion within a reasonable degree of medical certainty. Of course, the causal connection between employment and an injury does not ordinarily require expert medical testimony. However, the Commission did in fact rely on medical reports, and the only medical opinion that was given within a reasonable degree of medical certainty was given by Dr. Raben, who opined that appellant’s herniated disc was indeed caused by the incident at work.
Our supreme court has said that, if a doctor renders an opinion that goes beyond possibilities and establishes that a work-related accident was the reasonable cause of the injury, this will establish a reasonable degree of medical certainty. See Freeman v. Con-Agra Frozen Foods,
BAKER, J., joins.
. The concurring opinion takes issue with my reliance on the precedent of these cases, •which have not been overruled. It hardly seems right that adherence to established precedent should be the object of criticism.
Dissenting Opinion
dissenting.
The majority affirms this case reasoning that the analysis involves the competing opinions of two doctors. Characterizing the opinions as merely conflicting medical evidence, the májority further concludes that the resolution of the conflict was a question for the Commission leaving this court powerless to reverse the decision. While credibility is certainly the province of the Commission, it is the duty of this court to determine’whether the Commission’s decision is legally sound. In this case, the decision is not. The majority acknowledges that the basis of the Dr. Moffitt’s opinion supporting the Commission’s decision is appellant’s subjective manifestations of pain: “Dr. Moffitt stated that Hernandez’s complaints of left-side pain after her compensable injury did not
The opinion of Dr. Moffitt, upon which the Commission relied in denying benefits, was based upon appellant’s identification of pain on the left side of her body, which the doctor viewed as inconsistent with the herniation on the right that was clearly identified by the MRI. This opinion was given on September 1, 2005, the same day the MRI was conducted and shortly after the injury. As Dr. Moffitt’s treatment of appellant continued, his notations of appellant’s symptomology revealed a progression of pain. From September through January 19, 2006, these notations indicated appellant’s complaints of increasing pain on the right. On January 19, he stated that appellant had “a herniated nucleus pulposus by MRI of L5-S1 on the right. Some of the symptoms and physical findings that she demonstrates today are consistent with this.” Dr. Moffitt further opined that he was “not Inexactly sure” what “the next best step” would be, stating, “I am not sure that surgery would be an appropriate alternative at this time due to concerns with anxiety.” Nothing in the record supports a conclusion that Dr. Mof-fitt was evaluating surgei’y as an appropriate treatment for a- lumbar strain. He clearly stated that his concerns over the appropriateness of surgery stemmed from his patient’s anxiety level, not a concern that the surgery was an inappropriate treatment for her injury.
Subsequently, a discogram and CT were obtained that showed appellant to have pain at the L5-S1 level, the same level as the herniated disc. She was sent for a psychiatric evaluation, and it was recommended that she continue with psychiatric treatment following her surgical procedure; however, it was also recommended that she could go ahead and proceed with surgery.
Both the ALJ and the Commission found that appellant had suffered a com-pensable injury to her low back. ■ She experienced acute pain in her low back after lifting a 35-pound box, which caused her to seek treatment. On September 1 and 30, 2005, Dr. Moffitt observed muscle tightness and spasms. Based upon this information, the Commission found that appellant had suffered an accidental injury caused by a specific incident and identifiable by time and place of occurrence on August 11, 2005. The MRI, performed on September 1, 2005, corresponded with the first day that Dr. Moffitt observed the muscle spasm and showed the disc herniation at the same level of the spasm.
| lfiTherefore, there is no dispute that appellant suffered a compensable injury to her low back after lifting a box. There is no dispute that after the incident she suffered from lumbar strain evidenced by
The responsibility to weigh carefully, judge cautiously, and evaluate thoroughly the testimony of witnesses as an integral part of the fact-finding process bears heavily on the shoulders of the Commission. One obligation in its role as fact-finder is the Commission’s duty to use its experience and expertise in translating the testimony of medical experts into findings of fact. Bohannon v. Walmart Stores, Inc.,
Each participant in the process of evaluating a claim for workers’ compensation benefits must be diligent in performing the duties of each respective role. When deciding any issue, administrative law judges and the Commission shall determine, on the basis of the record as a whole, whether the party having the burden of proof on the issue has established it by a preponderance of the evidence. Ark.Code Ann. § 11 — 9—704(c)(2) (Repl.2002); Ark.Code Ann. § ll-9-705(a)(3) (Repl.2002); Excelsior Hotel v. Squires,
The ALJ in this case noted Dr. Moffitt’s belief that appellant’s symptoms did not | lscorrelate with the herniated disc on the right and his statement that there were no objective medical findings of a problem with appellant’s back; however, the ALJ did not thoroughly articulate in his decision the factual basis for Dr. Moffitt’s initial opinion nor the progression of Dr. Moffitt’s observation and treatment of appellant. Rather, the ALJ focused on Dr. Raben’s medical opinion, which hg found credible and entitled to great weight in awarding appellant benefits.
The fact that the ALJ did not thoroughly address the basis of Dr. Moffitt’s opinion, rendered early in his diagnosis and
It is this court’s duty to hold the Commission accountable, recognizing the balancing of rights with responsibilities. The Workers’ Compensation Commission has the right to find the facts, but that right carries with it the duty to make and set out the crucial findings of fact and the supporting evidence, and where the Commission fails to adequately detail findings of fact to enable the appellate court to properly review the record, the case will be remanded so that the Commission may then do so. McCoy v. Buckeye Cotton Oil,
The Commission must not only adequately articulate its findings; its duty as fact-finder carries with it the corresponding obligation to properly evaluate the medical opinions to determine if the facts upon which a doctor’s opinion is based are legally sufficient to support the opinion. In Bohannon v. Walmart Stores, Inc., supra, this court reversed a denial of benefits holding that the.expert physician opinion provided no basis for the Commission’s conclusion that the claimant did not require additional medical treatment for inhalation of chemicals used to clean air conditioning units. The expert assumed claimant did not suffer from symptoms that would normally accompany chemical inhalation, but medical reports revealed she suffered from those symptoms, and the treating neurosurgeon recommended an MRI scan of claimant’s brain which was never conducted because employer would not pay for it. This court explained:
The sole issue before this court is whether the Commission erred in determining that additional medical treatment, including but not limited to Dr. Rutherford’s recommendations, was not necessary. We hold that the Commission erred.
First, the Commission relied heavily on Dr. Foster’s expert opinion, and it is clear from the record that Dr. Foster’s opinion was based on several erroneous assumptions. Specifically, Dr. Foster admitted that he was unaware of the dimensions of the room where appellant worked; did not know the number of vents' in the room; did not know how much 2-butoxyethanol was put in the air conditioner unit; did not know how much of the chemical was blown into the room; and did not know how close appellant was sitting to a vent. Moreover, he was unaware of the length of her exposure. He assumed that appellant’s exposure time to the chemical was only a few |2nminutes. However, appellant’s co-workers testified that they left the work area thirty minutes after noticing the chemical odor, but appellant did not accompany them at that time. Rather, she remained behind at her workstation. Therefore, contrary to Dr. Foster’s assumption, appellant’s exposure was greater than thirty minutes.
Dr. Foster also made it clear during his deposition that the key factor in his opinion that appellant’s headaches and speech problems were not caused by 2-butoxyethanol was that appellant did not experience any eye, nose, and skin irritationin conjunction with her headaches. Dr. Foster agreed that those findings were at the “heart” of his opinion. Contrary to Dr. Foster’s opinion, the emergency-room reports revealed that immediately following her exposure, appellant experienced pain and blurry vision in her left eye, had redness in her nasal chambers, and appeared to have swelling in her lips and mouth.
Bohannon,
In Bohannon, the expert based his opinion upon erroneous assumptions. The expert’s opinion was based upon factual errors that rendered the assumptions and speculation upon which the opinion was based legally insufficient to support the doctor’s opinion. See Bohannon, supra. Similarly to the doctor’s reliance on assumptions that could not legally support a denial of benefits in Bohannon, Dr. Mof-fitt’s opinion relied on his patient’s description of pain. Certainly it was appropriate in the early stages of his diagnostic process to rely on appellant’s description of pain to help him determine the cause of appellant’s symptoms. While Dr. Moffitt’s reliance on his patient’s experience of pain is essential to his diagnostic process, the Commission is legally precluded from basing an award solely on a complaint of pain. Pain is a subjective symptom of an injury, and the experience of pain is individual in nature:
While one would think that normally a person who had been injured would immediately report such injury to his employer or fellow employees, this is certainly _[^ not a hard and fast rule. Rather, such action would seem to depend upon the individual nature of the person involved, some people being able to bear pain more than others, and, of course, a desire to continue employment for the purpose of earning wages could be a factor bearing upon this behavior.
Price v. Servisoft Water Conditioning Co.,
Descriptions of pain in the diagnostic stage of an injury are a critical aspect of the medical protocol. This court has recognized that the diagnostic process is just that, a process with various tests and evaluation techniques used to develop a medical opinion regarding the patient’s condition. See Amaya v. Newberry’s 3N Mill,
This court should not elevate a medical professional’s legitimate utilization of a patient’s identification of pain as a diagnostic technique into a legally sufficient basis for awarding or denying a workers’ compensation
. The concurrence’s discussion of the arbitrary disregard of evidence in the context of a worker's compensation case echos a concurring opinion in Pyle v. Woodfield, Inc.,
