Hameed Alfaraj v. S-3 Perspectives, Inc., d/b/a Express

This workers' compensation appeal has been referred to the Special Workers' Compensation Appeals Panel in accordance with Tenn. Code Ann. _5-6-225(e)(3) for hearing and reporting to the Supreme Court of findings of fact and conclusions of law. The employer appeals the judgment of the trial court finding that the employee sustained a work-related injury resulting in a 5% anatomical impairment and a 95% vocational disability to his right upper extremity. The employer contends that the evidence preponderates against a finding that the employee suffered from carpal tunnel syndrome; and that the trial court erred in relying on the testimony of the employee's medical expert. The panel has concluded that the judgment of the trial court should be affirmed. Tenn. Code Ann. _ 5-6-225(e) (1999) Appeal as of Right; Judgment of the Circuit Court Affirmed. JAMES L. WEATHERFORD, SR.J., in which JANICE M. HOLDER, J., and JOE C. LOSER, JR., Sp.J., joined. Stanley A. Davis, Nashville, Tennessee, for the appellee Hameed Alfaraj. Dale A. Tipps, Nashville, Tennessee, for the appellant, S-3 Perspectives, Inc., d/b/a/ Express Personnel Services. MEMORANDUM OPINION Mr. Hameed Alfaraj was 36 years old at the time of trial. He is an Iraqi who left his country after taking part in the uprising against Saddam Hussein during the Gulf War. He immigrated to the United States in 1996. He had 6 years of elementary education but is very weak in reading or writing Arabic. He cannot speak English. All of his jobs in the past have involved some type of manual labor and he has no job skills. On September 15, 2, Mr. Alfaraj injured his right hand while working for Express Personnel Services (Express). Mr. Alfaraj was lifting boxes weighing approximately 5 pounds each when he heard a loud pop and immediately felt pain in the wrist and palm of his right hand. He also saw a ball-like mass appear on his hand. He reported the injury to his employer and picked Dr. Barry Callahan from a panel of three physicians. On October 12, 2, Dr. Callahan, a board-certified orthopedic surgeon, diagnosed a ganglion cyst and recommended excision. Mr. Alfaraj also had a positive Tinel's sign and Phalen's maneuver. According to Dr. Callahan's records, Mr. Alfaraj reported that he sometimes had "some parenthesias when he had prolonged gripping or lifting. This has been present for 3-4 months and likely predates the onset of this mass." Dr. Callahan noted that "[h]e may have some carpal tunnel symptoms" and that releasing the carpal canal "would hopefully prevent future problems." He recommended a carpal tunnel release through the same incision for the excision of the ganglion cyst "and informed [Mr. Alfaraj through an interpreter] I would not get an EMG simply because the addition of release of the transverse carpal ligament through the FCR tunnel would not add any morbidity to the ganglion excision." On October 23, 2, Dr. Callahan performed the ganglion excision and a carpel tunnel release. In his operative report, Dr. Callahan noted Mr. Alfaraj "also reported some minor numbness and tingling in the median nerve distribution of his fingers and in addition to his mass had all the findings of carpal tunnel syndrome." In his deposition, Dr. Callahan stated he never made a diagnosis of carpal tunnel syndrome due to lack of symptoms. He compared doing the carpal tunnel release to "doing bowel surgery and taking out an appendix. You're probably going to head something off at the pass." He pointed out that you release half of the ligament taking out the cyst so it would be "absurd" not to release the rest of it. He characterized Mr. Alfaraj's carpal tunnel symptoms as equivocal or inconclusive because he did not have a positive median nerve compression test. However, Dr. Callahan did not order such a test prior to surgery. On December 5, 2, Dr. Callahan found that Mr. Alfaraj had regained full wrist mobility, assessed Mr. Alfaraj's wrist as having no objective loss and gave him a % impairment rating. Dr. Callahan later released Mr. Alfaraj from his care with no restrictions. On February 22, 21, he returned to Dr. Callahan complaining of pain in his wrist and hand while trying to sleep. Dr. Callahan provided him with a splint but still felt he had no objective loss. An EMG returned normal results. On January 14, 22, Mr. Alfaraj sought additional treatment from Dr. Choudhury Salekin, the Chief of Neurology at Veterans Administration Medical Center in Murfreesboro who has a part- -2-