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Markovich v. Helmsman Management Services1/31/2003
ant enough for Dr. Gregg Singer, a physiatrist, to prescribe a "Medrol Dosepak" on November 9, 1999. (Id.) Both Drs. Moseley and Sukin testified in their depositions that the neck pain may have to some extent masked claimant's back pain. (Sukin Dep. at 40-42; Moseley Dep. at 16-18, 21.)
f Referrals to medical specialists in the months prior to May 30, 2000, were for evaluation of claimant's neck, as would be expected given the severity and nature of his neck complaints. Dr. Singer, who initially saw claimant on October 12, 1999, noted that he was referred for "evaluation of neck pain." (Ex. 2 at 148.) Similarly, the referral to Dr. Moseley was for evaluation of possible nerve root irritation at C6-7. (Id. at 124.) It is entirely possible that claimant may have mentioned his back pain in passing to physicians treating him in October, November, and December and that those complaints were not noted on account of the focus on the neck. I note that Dr. Goodman, who saw claimant on May 31, 2000, devoted one sentence to claimant's back and leg complaints (quoted above in paragraph 13), and made no further mention of the matter in the rest of his notes, including in his impression.
Dr. Moseley's January 27, 2000 report states that claimant's " ow back and legs are symptom free." (Id. at 69.) This note, along with claimant's report in late October that his back pain had improved, persuades me that claimant's back pain had largely subsided by January 2000. However, I am also persuaded that by March 2000, the back pain had recurred in response to claimant's attempts to keep fit by walking and that it thereafter increased. By the time of Dr. Moseley's examination on May 30th, he not only reported back and leg pain but also had a positive straight leg raising sign in his left leg at 30°. (Id. at 81.)
As noted earlier, claimant underwent successful neck surgery in August 2000. On December 11, 2000, he returned to Dr. Moseley for follow-up. (Id. at 110.) At that time he complained of "recurrent low back pain going down his left leg two weeks ago." (Id.) Dr. Moseley noted that claimant stated that he had "been having back and leg discomfort since his injury , although he has not focused on it because of his neck disease." (Id.) The doctor ordered an MRI.
An MRI was done and it showed:
"Minimal annular disk bulge at L4-5 with small to moderate sized superimposed broad based central and left paracentral disk herniation with a moderate sized sequestered disk fragment within the left lateral recess and left ventral epidural space of L5 as described above. There is also a small far left posterolateral annular tear and disk protrusion. (Id. at 7, and see Id. at 111.)
The MRI report also noted "lateral recess stenosis." (Id.)
Dr. Moseley saw claimant again on February 5, 2002. At that time he noted his impression of " umbar radiculopathy" and recommended an updated MRI with a view to possible surgery. (Id. at 118.) At deposition he reiterated his recommendation for an MRI and predicted that surgery will be necessary. (Moseley Dep. at 10.)
Notwithstanding the caption in this case, the insurer at risk for claimant's injury was Liberty Northwest Insurance Corporation (Liberty). (Uncontested Fact 2.) Liberty has accepted liability for the claimant's neck condition and surgery but has denied liability for his low-back condition, alleging that it is unrelated to his industrial accident.
Both Dr. Moseley and Dr. Sukin testified on the causation issue. Dr. Moseley, as mentioned before, is claimant's treating physician and performed the surgery on claimant's neck. Dr. Sukin performed an independent medical examination
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