Lee, Chevis v. PAE Holdings Corp.

2025 TN WC 54
CourtTennessee Court of Workers' Compensation Claims
DecidedAugust 11, 2025
Docket2025-60-2116
StatusPublished

This text of 2025 TN WC 54 (Lee, Chevis v. PAE Holdings Corp.) 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
Lee, Chevis v. PAE Holdings Corp., 2025 TN WC 54 (Tenn. Super. Ct. 2025).

Opinion

FILED Aug 11, 2025 01:13 PM(CT) TENNESSEE COURT OF WORKERS' COMPENSATION CLAIMS

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

Chevis Lee, ) Docket No. 2025-60-2116 Employee, ) v. ) PAE Holdings Corp., ) State File No. 82916-2023 Employer, ) And ) Indemnity Insurance Company of ) Judge Kenneth M. Switzer North America, ) Carrier. )

EXPEDITED HEARING ORDER

Chevis Lee sought an order that PAE Holdings Corporation authorize surgery recommended by the treating physician. PAE contended that the proposed surgery is not reasonable and necessary based on utilization review reports. After an expedited hearing on July 31, 2025, the Court orders that PAE provide the surgery.

Claim History

Mr. Lee, a firefighter, injured his neck and left shoulder while doing pushups at work on November 1, 2023. PAE accepted the claim. He treats with Dr. Ryan Snowden, an orthopedic spine surgeon.

In March 2024, Mr. Lee saw Dr. Snowden’s physician assistant, who diagnosed cervicalgia with left upper-extremity radiculopathy and left-shoulder pain. She ordered additional physical therapy and an evaluation by a shoulder specialist.

A month later, Dr. Snowden personally examined Mr. Lee and noted a “positive left-sided Spurling’s, light pain with range of motion of the shoulder. He is distally neurologically intact with C7 dysesthesia in the left arm.” Dr. Snowden diagnosed cervical foraminal stenosis with radiculopathy. He wrote that Mr. Lee was still participating in

1 physical therapy principally for his neck. Dr. Snowden added that an epidural steroid injection might be necessary at C6-C7.

At the next visit in May, Dr. Snowden assessed cervical radiculopathy and left- shoulder pain, and he recommended still more physical therapy. He said an injection was unnecessary at that time.

In June, Dr. Snowden recorded that an MRI of the neck showed disc protrusion at C5-C6 and narrowing at C6-C7 into the nerve tunnels. He added that the pain originated from C6-C7 and C7-T1. He recommended injections targeting the right C7-T1 and left C6-C7 and an EMG nerve conduction study.

In July, Dr. Snowden noted that the EMG results were normal. Further, Mr. Lee’s shoulder specialist recommended surgery, which PAE authorized. The injections were administered in August.

At the next visit in September, Dr. Snowden’s physician assistant discussed potential surgery at C5-C7 and anterior cervical discectomy and fusion—the subject of this hearing. But they agreed that the shoulder took priority, and that surgery occurred in October.

After shoulder surgery, Mr. Lee returned to Dr. Snowden in early December reporting ongoing neck pain and intermittent tingling. The doctor wrote, “The patient has previously undergone conservative treatments, including physical therapy, anti- inflammatories, and epidural injections, which have not provided lasting relief. He has completed shoulder rehabilitation and is now ready to proceed with surgical intervention for his cervical radiculopathy.”

Immediately afterward, PAE submitted the recommendation to utilization review, resulting in noncertification of the surgery. Dr. Kimberly Terry, a neurological surgeon, noted that Mr. Lee is a former smoker, and a current MRI report was unavailable. She explained that the previous MRI report was over one year old, and Dr. Snowden’s evaluation in early December “did not include any specific physical exam findings.”

Mr. Lee appealed to the medical directors, who agreed with the denial. The medical directors reasoned, “It is suggested that a current MRI of the cervical spine be obtained, and an office reevaluation with a complete description of current symptoms and current neurologic exam be obtained[.]”

PAE did not authorize a visit with a neurologist. Instead, Mr. Lee returned to Dr. Snowden on January 28. Notes from the visit state that on examination, a Spurling’s test was positive on the left greater than the right, reproducing C6-7 radicular pain. Dr. Snowden wrote:

2 We have been treating the C5-6 and C6-7 levels with physical therapy, anti- inflammatories, and multiple epidural injections. The patient has also had shoulder surgery. Given the persistence of symptoms and the poor quality of the MRI read, we will have the MRI over-read by our neuroradiologist. We will continue to press forward with surgical clearance for the C5-C6 and C6-7 ACDF.

Dr. Snowden ordered another MRI, performed on January 29. The report documented “[m]oderate right and severe left foraminal stenosis at C6-7 with impingement of the exiting C7 nerve roots,” and “[s]mall central disc protrusion at C4-5 mildly flattens the ventral cord. Moderate left foraminal stenosis with small impingement of the exiting left C5 nerve root.”

PAE Holdings requested another utilization review, and on February 6, Dr. Steven Zielinski, a neurological surgeon, concluded that the surgery is not medically necessary. The report stated that among the documents he reviewed was an MRI performed on January 14, 2025, and read by “J. King III, M.D.,” but neither party offered a copy of this report into evidence. Dr. Zielinski wrote:

Review of the current records did not identify the claimant’s smoking status. Review of the cervical MRI report did not identify significant stenosis at either C5-6 or at C6-7. No nerve compression or impingement was detailed. The cord was normal. The current physical exam also did not detail any focal neurological defects in the upper extremities that would support the C5-6 or C6-7 levels as pain generators[.]

(Emphasis added).

Mr. Lee requested review by the medical directors, who agreed with the denial on February 20. They wrote: “It is suggested the ATP and the radiologist confer and issue a joint addendum for the 01.14.25 MRI. The alternative is a second opinion with the second opinion spine surgeon having access to actual MRI images.

PAE never offered a second opinion with a spine surgeon.

After Dr. Snowden learned of the denial in February, he made a “Note to Chart,” stating:

We reviewed his updated MRI report. He has based on my read confirmed on this new report, notable severe left C6-C7 foraminal stenosis. He also has central disc protrusion flattening of the cord, particularly in the lateral recess at C5-C6 with [sic] both correlates to his left arm symptoms. Again, I am

3 recommending C5-6, C6-C7, and ACDF[,] which are better correlated on this updated MRI with a much more adequate read.

An addendum to the “Note” reads, “This patient is a nonsmoker/never smoker.”

On March 10, Mr. Lee submitted the medical directors’ February letter to utilization review, along with a copy of the January 29 MRI report signed by Dr. Snowden and read by Dr. Hilary Orlowski.1 Utilization review characterized it as an “Inappropriate Duplicate Request.” Registered nurse Miranda Kent wrote that “the same request will not be processed again, absent objective documentation of a material change in the injured employee’s medical condition.”

Mr. Lee appealed that denial again to the medical director, who agreed with it. Dr. Robert Snyder wrote:

Not medically supportable in the absence of a thorough neurologic examination and agreement between the radiologist and the surgeon as to the MRI findings. 01.28.25 note does not describe the location of symptoms to permit assessment of possible appropriate levels for surgery. There is apparently no neurologic deficit on suboptimal documentation of physical exam. Distinguishing shoulder from neck symptoms is not possible with current history and exam. An EMG might be useful with the history of shoulder surgery.

Afterward, Mr. Lee sent Dr. Snyder’s denial to Dr. Snowden, who responded on April 14 with a dictated letter.2 In part, it says:

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Related

Orman v. Williams Sonoma, Inc.
803 S.W.2d 672 (Tennessee Supreme Court, 1991)

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2025 TN WC 54, Counsel Stack Legal Research, https://law.counselstack.com/opinion/lee-chevis-v-pae-holdings-corp-tennworkcompcl-2025.