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H. K. v. Woodridge Nursing Home (January 16, 2007)

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H. K. v. Woodridge Nursing Home (January 16, 2007)
STATE OF VERMONT
DEPARTMENT OF LABOR
H. K. Opinion No. 01-07WC
By: Margaret A. Mangan
v. Hearing Officer
Woodridge Nursing Home For: Patricia Moulton Powden
Commissioner
State File No. U-50905
Hearing held in Montpelier on October 31, 2006
Record closed on November 20, 2006
APPEARANCES:
Heidi S. Groff, Esq., for the Claimant
Keith J. Kasper, Esq., for the Defendant
ISSUES:
1. What is Claimant’s current diagnosis? Is it work related? Are the alleged right upper extremity complaints and bilateral lower extremity complaints related to her work related injury?
2. Is Claimant entitled to any permanent partial disability benefits for her work-related right wrist fracture and carpal tunnel syndrome? If so, what is the rating?
EXHIBITS:
Joint Exhibit I: Medical Records
Joint Exhibit II: Dr. Mathew’s deposition transcript
Claimant’s Exhibit 1: Dr. Matthew’s Curriculum Vitae
Defendant’s Exhibit A: Dr. Gennaro’s Curriculum Vitae
Defendant’s Exhibit B: Dr. Pulde’s Curriculum Vitae
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STIPULATION
1. On November 11, 2003, Claimant fell and sustained a right wrist fracture.
2. On November 11, 2203 Woodridge Nursing Home was covered by a workers’ compensation insurance policy issued by Liberty Mutual Insurance Company.
3. Liberty Mutual accepted the claim for a right wrist fracture and paid for medical bills associated with that claim.
4. Claimant also had preexisting bilateral carpal tunnel syndrome which was aggravated on the right sided. Claimant underwent right carpal tunnel surgery in June 2004.
5. On November 11, 2003, Claimant’s average weekly wage was $131.81, resulting in an initial compensation rate of $121.73.
FINDINGS OF FACT:
1. Helen Kennett became Helen Garneau in July 2006 when her divorce became final.
2. Claimant began working as a Food Service Worker at the Woodridge Nursing Home in June 2002. She worked forty hours every two weeks, washing pots and pans, doing assembly line work, and delivering food carts.
3. Claimant has been receiving social security benefits since 1996 for unrelated reasons, but worked despite the disability.
4. Claimant has diabetes that is treated with diet and medication, but not insulin.
5. John Matthew, M.D. has treated Claimant for twenty-five years.
6. Nerve conduction studies confirm, and all physicians involved in this case agree, that Claimant has diabetic neuropathy, a condition that affects the nerves in the extremities in many who have diabetes. Symptoms typically are lack of sensation or pain. Christopher Merriam, M.D., an orthopedist, documented the condition in October 2000. Dr. Matthew has treated Claimant for neuropathy since 2003.
7. In July of 2003, Christopher Bean, M.D., an orthopedic surgeon with expertise in hands, noted that Claimant had pain in her left hand when holding things.
8. In October and November 2003, Dr. Matthew noted that Claimant had low back and leg pain. An epidural injection to treat the pain was planned. At that time, Claimant was out of work for several weeks due to pain. Also in the fall of 2003, a physical therapist note indicated that Claimant had increased pain and decreased strength in her right foot.
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9. On November 11, 2003, Claimant was working when she tripped and hit her head and right wrist, fracturing the wrist. After a period out of work for treatment, Claimant returned to full time work mid May 2004.
10. In January 2004, Stephanie Landvater, M.D., the orthopedic surgeon who treated Claimant’s wrist fracture, first noted increased sensitivities suggesting an RSD (Regional Sympathetic Dystrophy) diagnosis.
11. Dr. Matthew diagnosed Claimant with diabetic neuropathy and with RSD; a chronic pain condition that he opined was caused by her work related injury. RSD is also called Complex Regional Pain Syndrome (CRPS).
12. RSD is a pain condition that comes on suddenly after an acute injury. In this case, the pain followed the wrist fracture and carpal tunnel surgery, both work related. Throbbing pain is characteristic as is exquisite sensitivity to touch, symptoms Dr. Matthew noted with Claimant.
13. As a consequence of that injury, she developed carpal tunnel syndrome in her right upper extremity that was surgically treated. On June 11, 2004, Dr. Landvater performed carpal tunnel surgery.
14. Sometime after the surgery, Claimant developed pain in her left hand and her feet.
15. Claimant’s employment with Defendant ended in October 2005 for reasons unrelated to this action.
16. Claimant now works fulltime at Project Independence, helping participants with meals and hygiene.
17. In support of the RSD diagnosis, Dr. Matthew noted that Claimant presents with allodynia, an exquisite sensitivity to light touch. In August of 2005, he specifically noted that the top of her foot prickled terribly; toes and the top of her foot were sensitive to touch; toes and fingers were shiny and swollen. Dr. Matthew opined that neither carpal tunnel syndrome nor diabetic neuropathy could explain the findings in her hands.
18. In response to the fact that Claimant returned to work after the development of RSD, Dr. Matthew noted that one theory for the treatment of RSD is to have the patient work through the pain.
19. At various times in the treatment process since her work related injury, Dr. Gennaro, Dr. Bean and Dr. Matthew have all suggested that RSD might be a diagnosis appropriate for this patient.
20. Victor Gennaro, D.O. is an orthopedic surgeon who based his initial impression of RSD on information available to him at the time of his September 15, 2004 examination: asymmetry between her hands; swelling in her right hand, fingers and wrist; vasomotor
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changes; skin color changes; hypersensitivity; restricted passive range of motion; and smooth, non-elastic skin texture.
21. Two months later, on November 18, 2004, Dr. Gennaro modified his original opinion regarding RSD. He determined that Claimant did not meet all of the criteria necessary for the RSD diagnosis, that he was unsure if she had RSD or vasomotor instability.
22. On January 19, 2006, Dr. Gennaro issued a third report after he had reviewed recent testing results and many medical records unavailable to him at the time of the earlier reports. Based on results of a bone scan and information from a pain management specialist, he determined that Claimant did not have RSD. He attributed her symptoms to diabetic neuropathy, and Raynaud’s syndrome.
23. George White, M.D., an occupational medicine expert, opined that Claimant’s preexisting right-sided carpal tunnel syndrome was aggravated by her work related wrist fracture. He assigned an 11% permanent partial impairment for the work related injury. However, Dr. White did not assign a permanency rating for the RSD because he did not find that she met the criteria for that diagnosis under the AMA Guides to the Evaluation of Permanent Impairment at the time of his evaluation in August 2006.
24. Milo Pulde, M.D. is board certified in internal medicine, with expertise in neurological and pain disorders. He reviewed Claimant’s medical records and examined her on February 13, 2006. Based on the review and examination, Dr. Pulde opined that it is possible, though not probable, that Claimant has RSD. He determined that Claimant has no permanent partial impairment attributable to the work related injury.
25. Dr. Matthew noted that in more than half the patients with RSD, pain crosses the midline so that one has pain in the previously unaffected extremity. He explained that RSD is not a static state, that symptoms can ebb and flow. It is possible that not all examiners detected the signs he assessed because the examinations were conducted at different times. Further, RSD has degrees of severity and is best treated in the early stages before the signs the defense experts believe are essential for a diagnosis, appear.
26. Diabetic neuropathy cannot explain the symptoms Claimant has in her extremities. Diabetic neuropathy causes pain and loss of other sensation in an extremity, not the hypersensitivity to light touch seen with RSD.
27. Claimant’s counsel has a one-third contingency fee agreement with Claimant and an approved attorney lien. Counsel spent $1,625.70 pursuing this claim.
CONCLUSIONS OF LAW:
1. In workers’ compensation cases, the claimant has the burden of establishing all facts essential to the rights asserted. Goodwin v. Fairbanks, 123 Vt. 161 (1962). She must establish by sufficient credible evidence the character and extent of the injury and disability as well as the causal connection between the injury and the employment. Egbert v. Book Press, 144 Vt. 367 (1984).
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2. There must be created in the mind of the trier of fact something more than a possibility, suspicion or surmise that the incidents complained of were the cause of the injury and the inference from the facts proved must be the more probable hypothesis. Burton Holden & Martin Lumber Co., 112 Vt. 17 1941. Where the causal connection between an accident and an injury is obscure, and a layperson would have no well-grounded opinion as to causation, expert medical testimony is necessary. J.G. v. Eden Park Nursing Home, Opinion No. 52-05WC (2005) (citing Lapan v. Berno’s Inc., 137 Vt. 393 (1979)).
3. When qualified medical experts disagree, as in this case, the Department has traditionally examined the following criteria in determining which opinions to accept: 1) the length of time the physician has provided care to the claimant; 2) the physician’s qualifications, including the degree of professional training and experience; 3) the objective support for the opinion; and 4) the comprehensiveness of the respective examinations, including whether the expert had all the relevant records. J.C. v. Richburg Builders Opinion No. 37-06WC (2006). (citing Miller v. Cornwall Orchards, Opinion No. 20-97WC (1997); Gardner v. Grand Union, Opinion No. 24-97WC (1997)).
4. Dr. Matthew has the advantage as the treating physician in this case, having treated Claimant for decades. He was familiar with her reaction to pain, her chronic conditions and her responses to treatment. Although clearly an advocate for the Claimant, there is no suggestion that his objectivity was in any way compromised. All experts are well qualified, although none has a specialty in the diagnosis and treatment of RSD. All conducted thorough examinations and reviewed relevant medical records.
5. All suggested at one time or another that Claimant had RSD. They were probably all correct. On balance I accept the opinion of Dr. Matthew as the most persuasive. He convinced me that RSD is not a static state, that symptoms can ebb and flow. It is likely that Claimant was not highly symptomatic at the time Dr. Pulde and others examined her. Dr. Matthew also convincingly explained that RSD has degrees of severity and is best treated in the early stages before the signs the defense experts believe are essential for a diagnosis, appear. Finally, I accept Dr. Matthew opinion that diabetic neuropathy cannot explain the symptoms he attributes to RSD. Diabetic neuropathy causes pain and loss of other sensation in an extremity, not the hypersensitivity seen with RSD.
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6. Accordingly, Defendant is responsible not only for the fractured wrist and carpal tunnel syndrome on the right, but also for medical treatment for Claimant’s RSD pursuant to 21 V.S.A. § 640(a).
7. If the permanent partial disability benefits have not yet been paid, Defendant is responsible for payment based on the 11% whole person rating assessed by Dr. White.
8. Pursuant to 21 V.S.A. § 678(a) and WC Rule 10. Claimant is also owed attorney fees based on 20% of the total award, not to exceed $9,000, and the necessary costs of $1,625.70.
9. Interest must be paid from the date each of the ordered benefits would have been paid had the claim been accepted, until paid. 21 V.S.A. § 664.
ORDER:
Therefore, based on the foregoing findings of fact and conclusions of law, Defendant must pay the benefits specified above for:
1. Medical Benefits;
2. Permanent Partial disability benefits
3. Interest;
4. Attorney fees and costs.
Dated at Montpelier, Vermont this 16th day of January 2007.
________________________________
Patricia Moulton Powden
Commissioner
Appeal:
Within 30 days after copies of this opinion have been mailed, either party may appeal questions of fact or mixed questions of law and fact to a superior court or questions of law to the Vermont Supreme Court. 21 V.S.A. §§ 670, 672.

D. D. v. W. T. Solutions, Inc. (February 23, 2007)

Categories: Workers' Compensation Hearing DecisionTags: , , , Author:

D. D. v. W. T. Solutions, Inc. (February 23, 2007)
STATE OF VERMONT
DEPARTMENT OF LABOR
D. D. Opinion No. 07-07WC
By: George K. Belcher
v. Hearing Officer
For: Patricia Moulton Powden
W.T. Solutions, Inc. Commissioner
State File No. W-60786
Hearing held in Montpelier on December 28, 2006.
Record closed on January 12, 2007.
APPEARANCES:
Steven P. Robinson, Esq. for the Claimant
Richard R. Hennessey, Esq. for the Defendant
ISSUES:
1. Should the Form 27, Employer’s Notice of Intention to Discontinue Payments, be accepted as a valid termination of temporary Workers’ Compensation benefits for the Claimant?
2. Has the Claimant established that her injuries are work related?
EXHIBITS:
1. Stipulated Medical Index with 40 medical records of the Claimant.
2. Legal bill of Diamond and Robinson, P.C., dated January 9, 2007
and filed on January 12, 2007.
FINDINGS OF FACT:
1. The Claimant worked for the Defendant from 2003 until May 9, 2005 as a supervisor and an industrial seamstress. Her general work was industrial sewing with repetitive use of her left arm and shoulder. The Claimant was an employee within the meaning of the Vermont Workers’ Compensation Act (Act) for all relevant periods. The Defendant was an employer within the meaning of the Act for all relevant time periods.
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2. In October of 2003, the Claimant was having left shoulder pain. In February of 2004 she underwent a left shoulder arthroscopic acromioplasty with Dr. Douglas Macarthur. This injury was rated at 7% whole person impairment on April 6, 2005 and was accepted as a compensable injury.
3. On May 9, 2005, the Claimant was at work, taping a cardboard box for her finished products, when she felt intense and debilitating pain in her left shoulder. She went to the emergency room at the hospital and reported that her pain flared up when she was taping the box. Joint Medical Exhibit, Tab. 2. Her visit to the emergency room was the start of many medical examinations and assessments which have not positively identified a structural cause for her pain. Her pain has continued from the onset on May 9, 2005 until the date of the hearing. She has been consistent in identifying the box incident as the start of her most recent shoulder problem. Joint Medical Exhibit.
4. The May 9, 2005 injury was accepted by the Defendant and benefits were paid until March 2006. A Form 27, Employer’s Notice of Intention to Discontinue Payments, was accepted by the Department on April 4, 2006. The Form 27 covered both medical benefits and temporary total disability benefits. Thereafter, no benefits have been paid.
5. Between May 9, 2005 and January 2006, the Claimant was treated by a variety of doctors and medical professionals who assessed her shoulder injury and pain. She was diagnosed with: (1) possible shoulder dislocation, (2) exaggerated protective response related to low grade muscularskeletal injury, (3) myofacial pain syndrome, and (4) “shoulder injury.” Joint Medical Exhibit.
6. In a report generated by Dr. Philip Davignon in September of 2005 at the request of the Defendant, Dr. Davignon essentially ruled out fibromyalgia as the likely cause of the Claimant’s pain. That same opinion was confirmed by Dr. Bruce Samuels in his report of October 5, 2005. Despite these two opinions, in February of 2006, Dr. Charles Carr gave a report which indicated that chronic myofacial pain syndrome/ fibromyalgia was her diagnosis and that she had no source of discomfort emanating from her shoulder. See Joint Medical Exhibit, Tab 28.
7. Thereafter, her nurse practitioner, Lili Cargill, listed her primary diagnosis as fibromyalgia on February 16, 2006. Joint Medical Exhibit, Tab 29.
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8. The records which supported the diagnosis of fibromyalgia were submitted to the Department with the Form 27. See Department filing of March 27, 2006 which included medical records from Dr. Shafritz, Dr. Carr, Physician’s Assistant Ryan Card and Nurse Practitioner, Lili Cargill. The Defendant’s insurance adjuster wrote to the Department indicating that the Claimant had “failed to provide medical evidence of a compensable related disability; current symptoms are not work related as Claimant has been diagnosed with fibromyalgia which is not compensable under the current circumstances.” See Letter of Nneka Oliphant to Department dated March 20, 2006.
9. What the Defendant did not submit to the Commissioner was the opinion of their own expert, Dr. Philip Davignon, of September of 2005. He had already determined that the Claimant did not meet the criteria for fibromyalgia. The insurer also did not include the report of Dr. Samuels of October 5, 2005 which had ruled out fibromyalgia. While the Claimant’s diagnosis may have been a complex determination, the insurer presented only the material which would make it appear as a simple diagnosis of fibromyalgia, despite its possession of records which showed that this diagnosis was questionable and disputed.
10. The other reason stated by the Defendant for the Form 27 was that the Claimant had not supplied evidence that her pain problem was work related. The Claimant was able to provide such an opinion shortly after the termination of her benefits. Dr. Graubert on February 27, 2006 gave a diagnosis of myofacial pain in the left shoulder, possibly a complex regional pain syndrome. In July of 2006, Dr. Jenkyn diagnosed that the Claimant had chronic pain syndrome as a direct consequence of the work injury on May 9, 2005. Dr. Davignon, in his impression section of his report, listed the first impression to be “History of left shoulder injury.” It was his testimony that the May 9, 2005 incident was a contributing factor to the overall problem with the left shoulder.
11. The attorney for the Claimant has submitted a bill for legal fees for a total of 77.00 hours of attorney and paralegal time for a total fee of $6,861.00 and reimbursable costs of $781.55.
CONCLUSIONS OF LAW:
1. In Worker’s Compensation cases the Claimant has the burden of establishing all facts essential to the rights asserted. Goodwin v. Fairbanks, 123 Vt. 161 (1963). The Claimant must establish by sufficient credible evidence the character and extent of the injury and disability as well as the causal connection between the injury and the employment. Egbert v. Book Press, 144 Vt. 367 (1984).
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2. There must be created in the mind of the trier of fact something more than a possibility, suspicion or surmise that the incidents complained of were the cause of the injury and the inference from the facts proven must be the more probable hypothesis. Burton v. Holden and Martin Lumber Co. 112 Vt. 17 (1941).
3. While the Claimant has the burden of proof in the first instance, once the claim is accepted and benefits are paid, the employer must show that the Claimant has either returned to work or that the discontinuance of the benefits is warranted. 21 VSA Sec. 643a. The burden of proof to terminate a claim which has been accepted is upon the employer. Merrill v. University of Vermont, 133 Vt. 101 (1974). Under Workers’ Compensation Rule 18.1100 the termination of benefits must be “adequately supported by evidence” as presented in the Form 27.
4. In this case, the Defendant chose to submit only the evidence which it had which supported a diagnosis of fibromyalgia, despite the fact that it had, in hand, the medical report of Dr. Davignon which said that the Claimant’s condition did not fit within the clinical criteria for a diagnosis of fibromyalgia. It is also probable that the Defendant had in its possession a second report from Dr. Samuels concluding that the Claimant did not have fibromyalgia.
5. The Form 27 clearly gives the employee a right to challenge the action taken on a Form 27 discontinuance of benefits. Thiverge v Groleau, Opinion No. 67-94 WC (April 20, 1995). Clearly, the Commissioner relies upon the evidence presented by the employers in support of terminations. If the employer submits only a slice of those medical records which support one conclusion, the employer runs the risk that benefits will be reinstated with attorneys fees and interest. Wilson v. Webster Corporation, Opinion No. 33S-00 WC (October 5, 2000). The Defendant has failed to sustain its burden of proof when all the relevant medical evidence is considered.
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6. It is also clear at this time that, even if the burden of proof were on the Claimant (which it was not) the Claimant could have, and did, present adequate evidence of causation between her pain condition and the injury of May 9, 2005. The Claimant presented opinions from Dr. Davignon, Dr. Graubert and Dr. Jenkyn, which, taken together with her own testimony, provide adequate, and persuasive evidence that the Claimant’s pain condition is related to her injury at work. This conclusion is also supported by the facts that the Claimant was working and would continue to be working but for the incident, her immediate onset of pain which the incident triggered, and her immediate and consistent complaint of pain from the time of the incident forward. (This common sense interpretation of the facts is what Dr. Davignon identified as his “impression” of a “history of left shoulder injury.”) Likewise, the Claimant has been consistent in her report of the onset of the problem and she immediately reported to medical providers that the work incident was the cause of her problem. Also, the injury of May 9, 2005 occurred with the backdrop of a prior work-related injury to the same shoulder which had been rated for a 7 % whole person impairment just two months before the May 9, 2005 injury. (The issue of aggravation/recurrence was not presented by the Defendant in this case.)
7. Under Vermont Workers’ Compensation Rule 10.0000, the Commissioner may, in her discretion, award reasonable attorneys fees to the prevailing party. Attorneys’ fees in the amount of $6,861.00 and costs of $781.55 are awarded to the Claimant. In addition, where payments are due, but unpaid, interest may be awarded. 21 VSA Sec. 664. In this case, the payments (both medical and temporary total disability benefits) were due by reason of the acceptance of the claim by the insurer. Given the earlier determination that the Form 27 was filed with selective medical reports, interest should be due on the retroactive temporary total benefits and medical benefits as they were due. See Hendry v. City of Burlington, Opinion No. 40-05WC (2005).
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ORDER:
Therefore, based upon the foregoing findings of fact and conclusions of law, the Commissioner determines that the Claimant is entitled to the following:
1. Medical benefits regarding the Claimant’s left shoulder injury and related pain condition;
2. Past TTD from the date of the last payment in March or April of 2006 to the present and ongoing until a medical end result is reached;
3. Attorneys’ fees of $6,861.00, costs of $781.55 and interest on the medical and disability benefits which would have been paid but for the Form 27 which was filed.
Dated at Montpelier, Vermont this 23rd day of February 2007.
____________________________
Patricia Moulton Powden
Commissioner
Appeal:
Within 30 days after copies of this opinion have been mailed, either party may appeal questions of fact or mixed questions of law and fact to a superior court or questions of law to the Vermont Supreme Court. 21 V.S.A. Sec. 670, 672.

Tammy Cochran v. Northeast Kingdom Human Services (August 12, 2009)

Categories: Workers' Compensation Hearing DecisionTags: , Author:

Tammy Cochran v. Northeast Kingdom Human Services (August 12, 2009)
STATE OF VERMONT
DEPARTMENT OF LABOR
Tammy Cochran Opinion No. 31-09WC
v. By: Jane Gomez-Dimotsis
Hearing Officer
Northeast Kingdom Human Services For: Patricia Moulton Powden
Commissioner
State File No. X-00726
OPINION AND ORDER
Hearing held in Montpelier on June 9, 2008
Record closed on August 8, 2008
APPEARANCES:
Vincent Illuzzi, Esq., for Claimant
John Valente, Esq., for Defendant
ISSUES:
1. Did Claimant suffer a work-related low back injury on August 9, 2005?
2. If yes, to what workers’ compensation benefits is she entitled?
EXHIBITS:
Joint Exhibit I: Joint medical record
Claimant’s Exhibit A: Physician’s Verifications of Disability and Out of Work Notices
Claimant’s Exhibit B: Telephone Deposition of Dr. Rowland Hazard, April 30, 2008
Claimant’s Exhibit C: Deposition Testimony of Dr. John Ajamie, May 12, 2008
Claimant’s Exhibit D: Telephone Deposition of Dr. William Spina, May 28, 2008
CLAIM:
Temporary total disability benefits pursuant to 21 V.S.A. §642
Medical benefits pursuant to 21 V.S.A. §640
Permanent partial disability benefits pursuant to 21 V.S.A. §648
Vocational rehabilitation benefits pursuant to 21 V.S.A. §641
Interest pursuant to 21 V.S.A. §664
Costs and attorney fees pursuant to 21 V.S.A. §678
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FINDINGS OF FACT:
1. At all times relevant to these proceedings, Claimant was an employee and
Defendant was an employer as those terms are defined in Vermont’s Worker’s Compensation Act.
2. Judicial notice is taken of all forms contained in the Department’s file relating to this claim, as well as to relevant sections of the AMA Guides to the Evaluation of Permanent Impairment, 5th Ed. (the “AMA Guides”).
3. Claimant was employed by Defendant as a vocational specialist. Her job involved helping disabled adult clients find and maintain employment in the community. One of her responsibilities was to demonstrate to clients how to perform their assigned job tasks, by visiting them at their job sites and physically working alongside them.
Claimant’s Background and Prior Medical History
4. Claimant has had a variety of prior work experiences. She has been the owner-operator of a gas station, an emergency family advocate at a supervised visitation center, and an aide for patients suffering from traumatic brain injuries. Claimant home-schooled her children and also ran a day-care facility. She has her GED and several years of college credits. She is computer literate, albeit with limited typing skills.
5. Claimant has carried a diagnosis of fibromyalgia since 1993, when she was involved in a motor vehicle accident. Her symptoms include muscle spasms and burning in her neck and left shoulder, and headaches as well. Claimant also has a history of depression. Most recently, since 2004 Claimant has treated for these conditions with her primary care provider, Dr. Ajamie, who has prescribed narcotic pain relievers and anti-depressants for her symptoms.
6. Claimant testified that notwithstanding her fibromyalgia, until her work injury (described below) she was able to engage in a variety of physical activities, including horseback riding, four-wheeling, hiking, swimming, walking and playing with her children and grandson.
7. At the time of her work injury Claimant was working only twenty hours per week. This was due in part to her family responsibilities – her father was in poor health and her daughter had a disabling condition that had flared up and required more care than previously. Claimant acknowledged that she was under a great deal of stress as a result of these family issues. She admitted as well that the pain from her fibromyalgia sometimes made it more difficult for her to do her job. In consideration of all of these factors, in May 2005 Claimant decided to cut her work hours back to half time.
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The Work Injury and Ensuing Medical Treatment
8. On August 9, 2005 Claimant was working with a special needs client at his job site, a local supermarket. Claimant entered a walk-in cooler to retrieve some frozen food product for the client. As she did so, she fell on the icy floor, hitting her lower back, tailbone, and left buttocks. Claimant immediately felt pain in her low back, down her left leg and into her foot. She took the client home and then went to the emergency room. There she was referred to her primary care physician, Dr. Ajamie, for ongoing treatment.
9. As noted above, Dr. Ajamie had treated Claimant regularly for both fibromyalgia and depression since 2004. He continued to do so after the August 2005 injury, administering anesthetic injections into Claimant’s upper body for her fibromyalgia and prescribing numerous narcotic pain medications, both for that condition and for her low back pain. Although Claimant had been able to work at least twenty hours weekly before the August 2005 incident, thereafter Dr. Ajamie determined that she was no longer able to do so. In keeping with Dr. Ajamie’s determination, Claimant has not worked since August 16, 2005.
10. Dr. Ajamie acknowledged that his role in Claimant’s treatment was as a primary care physician. For further evaluation of her orthopedic and chronic pain issues, ultimately he referred her to the Dartmouth Hitchcock Spine Center’s Functional Restoration Program (the “Dartmouth Hitchcock program”). The purpose of this program is not to “fix” a patient’s underlying condition, but rather to improve his or her ability to function nevertheless.
11. Claimant completed the Dartmouth Hitchcock program in November 2007. She acknowledged that the program failed to relieve her symptoms, but felt that it was successful in restoring some function. There remains some disagreement among the medical providers who have become involved in this claim as to how effective the program really was when considered in light of Claimant’s current level of function and physical capabilities. Even after completing the program, Claimant still does not believe she is capable of working. Nor does she feel able to participate in most of the recreational activities she enjoyed in the past.
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Expert Medical Opinions
12. Numerous medical providers have evaluated and/or treated Claimant in conjunction with her current claim. These include:

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