Dawson, Beandy v. Optum services, Inc.

2024 TN WC 25
CourtTennessee Court of Workers' Compensation Claims
DecidedMarch 27, 2024
Docket2021-06-0210
StatusPublished

This text of 2024 TN WC 25 (Dawson, Beandy v. Optum services, Inc.) is published on Counsel Stack Legal Research, covering Tennessee Court of Workers' Compensation Claims primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Dawson, Beandy v. Optum services, Inc., 2024 TN WC 25 (Tenn. Super. Ct. 2024).

Opinion

FILED Mar 27, 2024 02:43 PM(CT) TENNESSEE COURT OF WORKERS' COMPENSATION CLAIMS

TENNESSEE BUREAU OF WORKERS’ COMPENSATION IN THE COURT OF WORKERS’ COMPENSATION CLAIMS AT NASHVILLE

BRANDY DAWSON, ) Docket No. 2021-06-0210 Employee, ) v. ) OPTUM SERVICES, INC., ) State File No. 45004-2019 Employer, ) And ) STANDARD FIRE INS. CO., ) Judge Joshua D. Baker Carrier. )

EXPEDITED HEARING ORDER GRANTING BENEFITS

Ms. Dawson asked the Court to order medical treatment for thoracic outlet syndrome with vascular surgeon Dr. Robert Thompson, past and ongoing temporary disability benefits, and attorney’s fees. Optum denied the request, asserting the alleged thoracic outlet syndrome did not arise out of her employment.

For the reasons below, the Court holds Ms. Dawson is entitled to medical treatment with Dr. Thompson, past and ongoing temporary disability benefits, and attorney’s fees on the temporary disability benefits.

Claim History

Ms. Dawson worked for Optum as a nurse, visiting patients at their homes. In June 2019, while walking up a driveway, she “fell forward and landed on her outstretched hands/wrists[.]”

Optum accepted her claim and authorized treatment with several physicians for various injuries. Yet a few months into her care, her authorized doctors struggled to explain—or sometimes dismissed—upper extremity symptoms unexplained by diagnostic imaging.

1 Ms. Dawson complained of pain radiating from her neck and shoulder into the arms and down to the fingers, right-arm muscle weakness, numbness and tingling, right-hand coldness and finger discoloration, difficulty raising her right arm overhead, and paresthesia in her right hand.

Dr. Lucas Richie, the orthopedic surgeon treating Ms. Dawson’s right shoulder, recommended a neurologist and a spine surgeon, and he ordered physical therapy.

Four months post-injury, a physical therapist observed discoloration and coldness in Ms. Dawson’s right hand and fingers and considered her symptoms “suggestive of thoracic outlet syndrome[,]” which can occur when nerves become compressed after a physical trauma. Dr. Richie kept her in physical therapy “for continued strengthening and treatment of potential thoracic outlet syndrome.”

Meanwhile, Dr. Richie’s referrals to a neurosurgeon and spine surgeon did not yield any diagnosis that would explain Ms. Dawson’s symptoms. Dr. Christopher Kauffman, a spine surgeon, had little to offer and released her. Neurosurgeon Dr. Margaret MacGregor then treated her for two years but also could not explain her symptoms. Neither doctor diagnosed thoracic outlet syndrome.

Nearly two years post-injury, Ms. Dawson returned to Dr. Richie with “continued complaints of generalized right arm and shoulder pain” and complained that “Dr. MacGregor does not treat thoracic outlet.” So on March 19, 2021, Dr. Richie referred Ms. Dawson “to a brachial plexus specialist [for] further definitive evaluation [and] management of any potential nerve entrapment[,] which [I’m] not well versed in[,] and they can assume care for this.”

Ms. Dawson testified Optum never offered a panel of brachial plexus specialists. Instead, it questioned the appropriateness of Dr. Richie’s referral, sending him a questionnaire. He responded:

[A]n abnormality of the brachial plexus . . . is a rare diagnosis that I do not treat. There are few physicians that treat such a disorder[,] and if there is concern of this[,] it would likely require evaluation by a specialist in brachial plexopathy and not an orthopedic spine (Dr. Kauffman) or neurosurgeon (Dr. MacGregor) specialist.

While the syndrome’s rarity made it seem “unlikely,” he said, “I do not treat these types of disorders[,] and I could be wrong.”

Despite Dr. Richie’s direct statement on the recommended course of care, Optum did not offer treatment from a specialist. So Ms. Dawson consulted Dr. Thomas Naslund, a vascular surgeon, on her own.

2 Dr. Naslund diagnosed neurogenic thoracic outlet syndrome, a specific type of thoracic outlet syndrome caused by compression of the brachial plexus nerves, and he recommended surgery. Dr. Naslund balked over determining causation “to a reasonable degree of medical certainty” because he only examined her once. He wrote in a questionnaire response, “I cannot make that level of certainty. [She] provided verbal history indicating job injury caused chronic pain. My opinion of thoracic outlet syndrome is not proven. Only success with surgery would prove this.” He also thought surgery was not medically necessary if “tolerating symptoms as an alternative is reasonable.”

After Dr. Naslund diagnosed thoracic outlet syndrome, Drs. Kauffman and MacGregor weighed in on his opinion. Dr. Kauffman wrote, “I do not think there is any relationship between the slip and fall at work and thoracic outlet syndrome.” Specifically, he mentioned the lack of any cervical-rib abnormality on an MRI. For her part, Dr. MacGregor wrote, “I do not feel that the patient has thoracic outlet syndrome, nor do I feel that she has CRPS [Complex Regional Pain Syndrome] of the right upper extremity.”

Dr. Richie, however, did not place Ms. Dawson at maximum medical improvement and continued to insist she needed an evaluation by a specialist who treats thoracic outlet syndrome:

I did not place her at MMI. I am unable to find etiology responsible for her significant ongoing pain[.] . . . I do not treat or diagnose thoracic outlet. I cannot state whether this may be related to her injury[.] . . . For my diagnosis of shoulder pain[,] I do not anticipate the need for further care. However, a physician treating thoracic outlet may have [a] different opinion.

By December 2021, all the doctors treating Ms. Dawson had released her. So Ms. Dawson searched for an expert to treat her for thoracic outlet syndrome.

She found Dr. Robert Thompson, a board-certified vascular surgeon and brachial plexus specialist, with “uncommon” expertise in thoracic outlet. Dr. Thompson had focused his practice solely on the syndrome for 15 years and was also the director of a multidisciplinary center for thoracic outlet. He performed roughly 300 surgeries per year on only thoracic outlet cases. As he said, “That’s all I do.”

In his July 2022 written report, Dr. Thompson diagnosed Ms. Dawson with neurogenic thoracic outlet syndrome, just like Dr. Naslund. However, he also related it to her work accident and recommended surgery. He explained the surgery is medically reasonable and necessary, and he said that she cannot work until she receives it.

3 Three months after Dr. Thompson gave that opinion, Optum filed a Notice of Denial, asserting “[e]mployment did not contribute over 50% in causing thoracic outlet syndrome.”

Optum continued medical treatment for Ms. Dawson’s accepted injuries, and she presently sees Dr. Michael Hillegass, a physiatrist. However, she maintains her desire to treat her thoracic outlet syndrome through workers’ compensation, describing her symptoms as intolerable and an interference with her daily living activities and her ability to work.

During discovery, the parties deposed four physicians: two authorized physicians, Drs. MacGregor and Hillegass; and Ms. Dawson’s two experts, vascular surgeons Drs. Naslund and Thompson. Their deposition testimony is summarized below.

Dr. MacGregor, authorized neurosurgeon

In her deposition, Dr. MacGregor declined to give any opinion about thoracic outlet syndrome, saying, “I don’t have an opinion.” She sees “less than one percent” of patients with thoracic outlet syndrome and does not treat it. She deferred to the vascular surgeons on the diagnosis, its recommended treatment, the maximum recovery date for that condition, permanent impairment, and causation.

Dr.

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Related

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Bluebook (online)
2024 TN WC 25, Counsel Stack Legal Research, https://law.counselstack.com/opinion/dawson-beandy-v-optum-services-inc-tennworkcompcl-2024.