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Thornton v. Volt Services Group6/16/2005
other. Shortly before the surgery, Dr. Morassuti asked him where his pain was. He stated that when he explained he was presently having pain on the left side, Dr. Morassuti decided to cancel the procedure.
Dr. Guarnaschelli evaluated the claimant on June 19, 2002, for the employer. His report indicated that he interviewed and examined the claimant and reviewed some x-ray and MRI evidence, but it did not include a history, a list of the claimant's complaints, or a list of Dr. Guarnaschelli's physical findings. The report consisted of answers to four questions that it stated the employer had posed in a letter. It did not repeat the questions or include a copy of the letter to which it referred. First, the report stated that the claimant had both clinical and radiographic evidence of low back, left hip, and left leg pain, noting that diagnostic tests revealed a central and left paracentral disc protrusion without an obvious extrusion. Dr. Guarnaschelli attributed the claimant's symptoms to the May 30, 2000, injury but thought that there was some degree of pre-existing symptomatic and/or asymptomatic lumbar spondylosis and degenerative changes. Second, Dr. Guarnaschelli noted that the claimant attributed 90% of his current symptoms to back pain and "far less than 10% of his symptoms" to the pain and numbness in the legs. Dr. Guarnaschelli did not recommend surgery because although it would help relieve the claimant's leg symptoms, it would do very little to relieve the chronic and disabling back pain. Nor would it permit him to return to heavy labor or construction work. Third, Dr. Guarnaschelli thought that the claimant could perform light-duty work that involved minimal lifting or bending and allowed frequent breaks but could not return to heavy labor, repetitive bending, working overhead, or prolonged standing, sitting, or crawling. Fourth, convinced that the claimant had reached maximum medical improvement (MMI), Dr. Guarnaschelli assigned a 5% impairment for an unspecified condition using the AMA's Guides to the Evaluation of Permanent Impairment (Guides), 2000 ed., Table 15-3, DIRE Category II.
Dr. Lach evaluated the claimant on August 1, 2002, at the request of counsel and completed a Form 107 report. His report relates the history he took from the claimant but contains nothing to indicate that he conducted a physical examination. Dr. Lach reviewed the course of treatment, noting that an MRI done on September 25, 2001, revealed, among other things, a right paracentral disc herniation at L5-S1, with associated right S1 nerve root effacement but no evidence of spinal canal or neural foraminal narrowing; underlying disc degeneration; and a central disc bulge at L4-5, with underlying findings suggesting a small annular tear but no evidence of spinal canal or neural foraminal encroachment. Dr. Lach noted that the herniation was consistent with the radicular pain in the right leg that was no longer severe on the eve of the proposed surgery; whereas, the left-sided pain that predominated was consistent with the L4-5 disc bulge on the left. A March, 2002, MRI revealed degenerative disc disease at L4-5 and L5-S1; the L5-S1 disc protrusion, which continued to touch the right S1 nerve root; and the L4-5 bulge, which had increased slightly.
Dr. Lash agreed with Dr. Guarnaschelli that the claimant was not a candidate for surgery; that he should be urged to undergo a physical therapy program; and that he was presently at MMI but did not retain the physical capacity to return to the type of work he performed at the time of injury. He thought that the claimant did not have a pre-existing active impairment. Noting that Dr. Guarnaschelli assigned a 5% impairment rating, Dr. Lach stated that he though
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