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Injured Worker’s left toe injury amended to include complex regional pain syndrome. Insurance Company’s Review/Termination/Suspension Petitions denied.

Trevon Landis (name changed for this summary) was injured in the course of his employment in Muncy, Pennsylvania (PA).  PMA, the workers’ compensation insurance carrier for the employer, issued a Notice of Temporary Compensation Payable (NTCP) on December 23, 2014 for Mr. Landis’ November 3, 2014 injury described as a left great toe dislocation.  The NTCP converted to a Notice of Compensation Payable (NCP) on February 3, 2015.


We filed a Review Petition seeking to have the description of injury amended to include complex regional pain syndrome (CRPS) of the left lower extremity and chronic neuropathic pain syndrome.  The Defendant filed Termination, Suspension, Modification and Review Medical Treatment Petitions alleging that Mr. Landis was fully recovered from his work injury as of October 28, 2015, based upon the opinions of Dr. Allardyce, who performed an independent medical examination on Mr. Landis.  The Defendant alleged that he was offered work on December 1, 2015 which he did not return to and that his medical treatment was not  related to the work injury.  Mr. Landis testified that he did return to work on various occasions after his injury occurred but that he had not worked for Defendant since July 24, 2015.  The parties agreed that Mr. Landis was offered the job in December 2015 but that he did not return because his physician had not released him to return to any work.  Tara Jordan, who worked for Defendant, testified that they would make efforts to accommodate his work-related restrictions.


Mr. Landis testified that he had surgery on November 13, 2014.  He testified that he continues to have constant excruciating pain in the foot and up and down his calf as well as swelling of the foot.  He underwent neuropathy treatments, electric shock treatment, laser, infrared light, aqua therapy and that he had to elevate his foot to relieve his symptoms.  He testified that the pain felt like razor blades were cutting him from his knee down to his foot, that he had cramps in his foot and that it felt like his great toe nail had been ripped off.  He has difficulty walking and avoids physical activity.  He was prescribed several medications including Lyrica, Gabapentin, Meloxicam, Tizanidine, Hydrocodone, Dulcolex, Senolax, Oxycodone and Tramadal.  He has lost 25% of the hair on his left leg at the ankle and he cannot sit or stand over 15 minutes.  Due to his altered gait, he has suffered pain in his right ankle, right shoulder and low back.  He testified he did not believe he could work in any capacity.


Dr. Bruce Levin testified that Mr. Landis’ pain is very severe and that he is suffering from CRPS and neuropathic pain.  Dr. Levin reported that Mr. Landis has had positive results with the spinal cord stimulator which was permanently implanted in June 2015. Mr. Landis suffered an increase in his symptoms and an onset of burning pain in January 2016.  Dr. Levin opined that Mr. Landis had surgery to repair his toe and later, hardware had to be removed which led to the development of a peripheral neuropathic injury which progressed to CRPS and that he was not recovered from his injury, in fact, he was totally disabled from same.  Dr. Levin also testified that Mr. Landis could possibly return to work to a desk job at some point in time, but not immediately.


The IME physician, Dr. Allardyce, testified that Mr. Landis had to undergo foot surgery which involved pinning of his great toe due to his work injury.  He later had to have a spinal cord implanted and was continuing to receive epidural injections.  He also testified that Mr. Landis was limping at the time of the IME.  Dr. Allardyce also reviewed MRI studies which showed Mr. Landis had advanced arthritis and a malunion of the previous fracture but he disagreed that Mr. Landis had CRPS and that the use of a brace and a cane that he was using could worsen the condition of varicose veins in the foot.  He further testified that it was opinion that the surgery was unnecessary and that the diagnosis of a dislocation of the great toe was incorrect and that the great toe was actually dislocated as part of the procedure.  He did not think Mr. Landis sug=ffers from RSD or CRPS and that any disability is not related to this work injury and perhaps related to a pre existing condition where he broke the same foot and toe. Dr. Allardyce was aware that Mr. Landis’ treating physicians, Dr. DiSimone, Dr. Sather and Dr. Levin had all diagnosed him with CRPS and that Dr. DiSimone and Dr. Sather also diagnosed him with chronic neuropathic pain syndrome.


The Judge found Mr. Landis credible as to his explanation of the injury and his symptoms and disability.  The Judge found that Dr. Allardyce, the IME physician, was not credible in testifying that he could return to work without restrictions and that he did not suffer from CRPS because he only had a limited opportunity to evaluate Mr. Landis.  The Judge found Dr. Levin to be credible in testifying that Mr. Landis was not fully recovered his work injury and that he developed CRPS of the left lower extremity and that he remains totally disabled.


The Judge granted Mr. Landis’ Review Petition and the accepted description of injury was amended to include complex regional pain syndrome of the left lower extremity.  The Judge denied the Defendant’s Termination, Suspension, Modification and Review Petitions.  Mr. Landis will continue to receive TTD wage loss benefits until his condition should change in accordance with the Act with Defendant being liable for payment of his related medical bills and costs of litigation.

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