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Hand v. Royal Insurance Company of America12/19/2002
and an EMG was done to rule out carpel tunnel syndrome. (Ex. 7 at 73.) On August 30, 1999, she complained of right arm and hand numbness. (Ex. 7 at 52.) A comprehensive review of her arm and hand complaints is unnecessary and is not undertaken here.
In any event, claimant returned to Dr. Weinert on July 5, 2001, which was three days after the work-related incident. On that date the claimant complained of "right lower rib pain, which is worse with deep breathing," as well as left low back pain. (Id. at 18.) These complaints were consistent with what she reported to the ER physician on July 2nd. In addition, she complained of neck pain "with bilateral arm numbness and tingling digits four and five." (Id.) Dr. Weinert noted that he had already scheduled an MRI of her neck for the next day, July 6th. (Id.) Insofar as the July 2nd incident is concerned, he noted, "Exacerbation of preexistent fibromyalgia with cervical, thoracic and lumbar region myofascial region pain, secondary to work injury of 7-2-01." (Id. at 19.)
The MRI was done on July 6th as scheduled. It disclosed
prominent arthritic change with posterior osteophytic spurring and moderate to severe spinal canal stenosis at C3-4 and C5-6 levels with disk bulges at C4-5 and C6-7 levels. There appeared to be some left sided lateralization at the C4-5 level impinging on the left C5 nerve root. (Id. at 14.)
On July 11, 2001, when claimant next saw Dr. Weinert, she was continuing to complain of arm numbness. (Id.) He noted the MRI results and ordered an EMG and nerve conduction studies. (Id. at 15.) He also referred her to Dr. Rizzolo "regarding her significant cervical spinal stenosis evidenced on MRI." (Id.)
Dr. Rizzolo saw claimant on August 15, 2001. (Ex. 9.) The exhibit notebook contains his office note for that date (which appears incomplete), a note dated September 7, 2001, and his September 7 and September 31 , 2001 letters to Royal Insurance's claims adjuster. (Id.) Lacking are Dr. Rizzolo's other medical records, including his operative report, although the operative report was available to Dr. Weinert during his deposition. (Weinert Dep. at 11.)
Dr. Rizzolo's assessment of claimant's neck condition on August 15th was " ervical spinal stenosis with myelomalacia" and " robably early myelopathy correlating with her stenosis." (Ex. 9 at 9.) "Myelomalcia is a condition where there's actual loss of neurologic elements; in other words, there is atrophy or thinning of the [spinal] cord." (Weinert Dep. at 24.) As noted earlier, Dr. Rizzolo thereafter (August 27, 2001) operated on claimant's neck.
Dr. Rizzolo was asked for his opinion of the relationship between claimant's cervical condition and surgery and her July 2nd accident. On September 7, 2001, he reviewed at least some of her medical records from Dr. Weinert. (Ex. 9 at 5.) Noting that claimant had been scheduled for an MRI prior to July 2nd he wrote, "The question that arises is whether or not the myelomalacia that was seen on her study of 7/6/01 was caused by her injury on 7/2 or whether it was a pre-existing condition." (Id. at 6.) He demurred to Dr. Weinert for an opinion, writing:
I believe the ultimate judgment on this depends upon Dr. Weinert's opinion. He is in the best position to determine whether or not the patient's symptoms changed dramatically. If in fact the symptoms did change dramatically in that she developed substantial bilateral arm numbness and tingling with coughing and sneezing then it is my opinion then that it is certainly possible that a fall from one foot could have caused the spinal cord contusion which necessitated her surgery. On the other hand if she had pre-exis
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