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Munroe v. Montana Electric & Telephone Pool8/16/2001
raged her to be careful with her activities and to gradually increase activities as tolerated. (Id.) He put her at "very close to maximum medical improvement." (Bonfilio Dep. at 50.)
Claimant returned to Dr. Bonfilio on August 11, 1999, reporting more activity and "increased discomfort about the shoulder and arm." (Ex. 5-J at 10.) She complained that "when she is 'stressed,' the arm will hurt from the base of the neck all the way out to the forearm and hand," that repetitive activities caused her discomfort, and that when sleeping on her stomach or elevating her arm, her arm went numb. (Id.) Claimant admitted "that she will tend to push activities further than she should, as a result, exhausting the muscle units of the shoulder and increasing the local discomfort." (Id.) Dr. Bonfilio's examination of claimant, showed no significant limitations in claimant's strength or range of motion.
Dr. Bonfilio testified that at the time of his August 11th exam, claimant had complaints of "numbness from the neck all the way to the fingertips, [which] is what we refer to as a non-dermatomal distribution," meaning that the numbness did not correspond to physiological nerve distributions. (Bonfilio Dep. at 51-52.) With regard to the surgery, Dr. Bonfilio continued to believe "she was doing very well." (Id. at 52.) He advised claimant to maintain a reasonable level of activities.
In October 1999, three significant things occurred. On October 11, 1999, claimant telephoned Dr. Bonfilio's office to request a referral to Dr. Lee Finney, a neurosurgeon. (Ex. 5-J at 10.) Second, on October 20, 1999, Dr. Bonfilio put claimant at maximum medical healing. (Exs. 2, 4, and 5-J at 17.) Finally, at the end of October 1999, claimant's job with Sun River was eliminated due to installation of automated meters which transmit meter readings directly to the central office. Claimant had known for at least six months prior to her termination that her job was going to be eliminated. (Munroe Dep. at 35.)
Dr. Lee Finney is a board certified neurosurgeon practicing in Great Falls. (Finney Dep. at 3-4.) He first examined claimant on October 19, 1999. (Id. at 4-5.) Her primary complaint was "right shoulder, right arm, and right medial scapular and right chest pain." (Ex. 5-K at 7.) Dr. Finney summarized claimant's history as follows:
47-year-old female, who 2 years ago fell on the job . She's had this difficulty since. It's been progressive. Two years ago, Dr. Gorsuch ordered MRI of the lumbar and cervical spine, without any significant findings, she also had negative EMG at that time. She subsequently had right shoulder surgery by Dr. Bonfilio. She's still having problems. (Id.)
Dr. Finney examined claimant and recorded:
Normal with symmetric reflexes. Plantar stimulation is flexor; there's no ankle clonus. There's no specific numbness though the right arm frequently falls asleep, first with the last 3 fingers of the right hand and then later on with the thumb and index finger of the right hand, though she doesn't describe any radicular pain in her right upper extremity. Her symptoms sound like spinal cord compression, perhaps from the cervical and certainly very much like spinal cord compression in the thoracic area. (Id.)
Based on the limited findings of his examination and claimant's subjective complaints, and without the benefit of claimant's medical records or imaging studies, Dr. Finney concluded that claimant had spinal cord compression at the thoracic and cervical levels, and possible nerve root compression from a herniated disc at the L2-3 level. (Id.; Finney Dep. at 5, 8.)
Dr. Finney ordered new MRI imaging studies (Ex. 5
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