eNotes: Workers’ Compensation – April 2023 – Virginia

SIGNIFICANT CASE SUMMARIES

Virginia Case Summary

Tyreese Haynes v. Food Lion #1451
Virginia Workers’ Compensation Commission
VA00001526899

Decided March 14, 2023

A CRPS diagnosis was upheld as compensable even without objective symptoms.

Background

Claimant sustained an injury when a 300 pound pallet jack crushed his right foot. After years of treatment and “odd neuralgia like pain,” Claimant’s podiatrist, Dr. Wax, was worried he may suffer from Complex Regional Pain Syndrome (“CRPS”). The doctor ordered an EMG and a bone scan, all of which came back negative. In a questionnaire response, Dr. Wax opined that “for this moment” CRPS could be ruled out. Claimant was referred to a different neurologist Dr. Harris, who saw coloration changes consistent with CRPS and gave him a formal CRPS diagnosis. In response to Dr. Harris’ opinion, Dr. Wax then concurred and agreed that Claimant suffered from CRPS. The carrier denied multiple avenues of treatment, including a spinal cord stimulator and an electric wheelchair. The carrier sought two IMEs, each of which indicated that Claimant “did not meet the Budapest CRPS criteria,” and therefore Claimant could not suffer from CRPS.

The Deputy Commissioner found that Claimant met his burden of proving CRPS, favoring the opinions of the treating physicians over the two IME doctors, even though Dr. Wax initially opined that Claimant did not suffer from CRPS.

Holding

The Full Commission affirmed. Even though Claimant did not meet the objective criteria for CRPS under the Budapest scale, the Commission “is not bound by any specific guides or medical authority when making its findings.” Beyond that, the Commission fell back on its well-worn maxim that the opinion of IME doctors defer to the opinion of the treating physician, and it was not error for the Deputy Commissioner to rely on the latter over the former.

Takeaway

Even when a claimant does not meet rigid, objective criteria, the Commission can and will often defer to the treating physician. CRPS in particular is a difficult diagnosis to overcome, so take particular care in your handling of claims when CRPS is involved.

Questions about this case can be directed to Mike Bliley, Esq. at (571) 464-0435 or mbliley@tthlaw.com.