Nikki F. Nelson v. Magnetic Separation Systems, Inc., and

This workers' compensation appeal has been referred to the Special Workers' Compensation Appeals Panel in accordance with the Tenn. Code Ann. _ 5-6-225(e)(3) for hearing and reporting findings of fact and conclusions of law. The employee contends the Chancellor erroneously: [1] considered as substantive evidence the medical report of Dr. Miller; [2] failed to find her elbow, shoulder, neck and spine disabilities were caused by her work, and therefore [3] rendered an inadequate award. As discussed below, the panel concludes that the parties offered voluminous medical records, including those of Dr. Miller, which were, without objection or limitation, treated by the parties throughout the trial as substantive evidence. The chancellor properly treated those reports as substantive evidence. The panel further concludes the chancellor's decision limiting the award to work-related disability to the hands and wrists is supported by a preponderance of the evidence, and that the award of 2 percent disability to both arms should be affirmed in all respects. Tenn. Code Ann. _ 5-6-225(e)(3) Appeal as of Right; Judgment of the Chancery Court Affirmed. JOHN A. TURNBULL, Sp. J., in which FRANK F. DROWOTA , III, and FRANK G. CLEMENT, JR.,, Sp.J., joined. Peter D. Heil and Michael A. Friedland, Alan Wise, Stillman, Karr, & Wise, Nashville, TN, for the appellant, Nikki F. Nelson Sean Antone Hunt, Spicer, Flynn & Rudstrom, PLLC, Nashville, TN, for the appellees, Magnetic Separation Systems, Inc. and Travelers Insurance Co. MEMORANDUM OPINION Nikki Nelson worked for Magnetic Separation Systems as an electronics technician, a job which included assembling electronic devices. Her job included some highly repetitive work with screwdrivers and other hand tools. There is a significant dispute in the testimony and other evidence as to whether the tasks required hand and wrist activity which were both forceful and repetitive. Live demonstrations of the tasks required and a video tape of the assembly work were a part of the evidence at trial. Ms. Nelson was not a happy employee. Her 18 month tenure with her employer was marked with numerous inter-office memos demonstrating a deteriorating relationship with her supervisors, and dissatisfaction by the employer with the quantity and quality of Ms. Nelson's work. During her last months of work for MMS, Ms. Nelson began having hand and wrist problemsand reported: "My hands and wrists were hurting from doing coil bobbins all day. Normally I would work until my hands fell off, but being put on 3 days probation and all, my husband told me to go to the doctor." The first among many doctors who treated Ms. Nelson was Dr. David McCoy, her family doctor, who first saw her on February 5, 1995. Clinical testing and the history related by Ms. Nelson caused Dr. McCoy to form the opinion that she had work-related carpal tunnel syndrome. Ms. Nelson then selected Dr. Jack Miller, an orthopaedic surgeon, from a list of doctors furnished by MMS. Dr. Miller treated her from February 14, 1995 until September, 1996. On his initial examination, Dr. Miller, based on Ms. Nelson's complaints of rather severe pain in both wrists together with positive Phalen sign and Tinel sign, diagnosed carpel tunnel syndrome and referred her to a neurologist for EMG testing. Dr. Miller was "shocked" that Ms. Nelson's initial EMG was normal and elected not to perform carpel tunnel release surgery at that time, but instead, Dr. Miller treated Ms. Nelson conservatively with physical therapy and cortisone injections. Dr. Miller directed that she not work. When Ms. Nelson's symptoms did not improve, Dr. Miller, in March, 1995, thought "carpel tunnel release is going to be justified, being recommended even though EMG's are normal." The employer then referred Ms. Nelson to Dr. Stephen Pratt for a second opinion. Dr. Pratt was "most certain that it is not carpel tunnel syndrome" and did not recommend carpel tunnel release surgery. Upon receiving Dr. Pratt's report, Dr. Miller elected not to proceed with surgery at that time. Dr. David Gaw did an independent medical exam in October, 1995, and agreed with Dr. Miller that Ms. Nelson had carpal tunnel syndrome, and recommended that she have surgery, even without a positive EMG. Dr. Miller again examined Ms. Nelson in October of 1995, and "strongly recommended carpal tunnel release" because of her persistent, long-standing complaints and clinical symptoms. Not satisfied to authorize surgery, the worker's compensation insurer, Travelers, sought a fourth opinion from Dr. Michael Milek who examined Ms. Nelson in January, 1996. Dr. Milek found "classic" carpel tunnel compression phenomena" and opined that "in all likelihood, she does have bilateral carpel tunnel compression." He recommended a repeat electrical study, and if "the electrical study is abnormal, then I would recommend carpel tunnel release." Finally, in May, 1995, surgery was authorized by Travelers, and bilateral carpel tunnel release surgery was performed on May 8, 1996, by the company doctor, Dr. Jack Miller, who noted during surgery that "the median nerve did not appear to be significantly altered." In subsequent visits in May, June, July, September of 1996, Ms. Nelson reported serially to Dr. Miller "her pain is 95 -2-