Hawaii Labor and Industrial Relations Appeals Board



Linda M. Andrade,



County of Hawaii,

Hawaii Police Department,

Employer-Appellee, Self-Insured


Case No. AB 2001-307(H); 1-00-00860

2003 HI Wrk. Comp. Lexis 3

January 22, 2003


Randall T. Iwase, Chairman; Carol K. Yamamoto, Member; Vicente F. Aquino, Member 


Decision and Order 


   This workers' compensation case is before the Board on appeal by Linda M. Andrade ("Claimant") from the decision of the Director of Labor and Industrial Relations, dated July 3, 2001. In that decision, the Director denied Claimant's claim for workers' compensation benefits. 


   The sole issue on appeal is whether Claimant sustained a personal injury on or about July 7, 2000, arising out of and in the course of employment. 


   The parties waived a trial in the above-entitled matter and submitted the case to the Board for decision based on the record and their respective position memoranda. 


   For the reasons stated below, we affirm the Director's denial of compensability.


Findings of Fact 


   1. Claimant was employed as a police radio dispatcher for County of Hawaii, Hawaii Police Department ("Employer") for over 19 years. 


   2. In her job as police dispatcher, Claimant operated various equipment that included computer keyboards, radio consoles, telephones, fax machines, printers, and dictaphone recorders. 


   3. On November 22, 2000, Claimant filed a claim for workers' compensation benefits, alleging that she sustained a work injury on July 7, 2000, as a result of poor office  ergonomics and having to make "rapid" and "repetitive" bodily movements at work on a daily basis for many years.


History of Musculoskeletal Pains Prior to 7/7/00


   4. Claimant has a history of musculoskeletal aches and pain. 


   5. In February of 1994, Claimant saw Dr. Heajung Ruesing, her internist, for complaints of heaviness on the right side of the body of three days' duration. Dr. Ruesing diagnosed muscle spasm and prescribed medication. 


   6. In May of 1995, Claimant saw Dr. Ruesing for pain radiating from the right side of the neck down to the shoulder, back, thigh, and leg of two days' duration. Examination showed no abnormalities. Dr. Ruesing diagnosed right-sided muscle ache and prescribed medication. 


   7. In August of 1995, Claimant was treated for migraine headaches and pain from the head down to the neck and arms. Dr. Ruesing diagnosed persistent neck pain without radiculopathy and tension headache. Dr. Ruesing referred Claimant to Dr. Ravi Pillai, a neurologist. 


   8. In September of 1995, Claimant saw Dr. Pillai for headaches and right-sided pain radiating all the way down to her hip. Neurological examination was normal. Dr. Pillai's assessment was migraine and vascular tension headache. 


   9. A CT scan of the head, performed on October 2, 1995, was normal. 


   10. An EEG, performed on October 2, 1995, was normal. 


   11. Claimant treated with Dr. Pillai for her headaches. 


   12. In March of 1996, Claimant saw Dr. Ruesing for right arm pain. X-rays of the right forearm and right elbow, performed on March 27, 1996, were normal. 


   13. In January of 1998, Claimant began seeing Dr. Alice Adee for fatigue, depression, and abdominal symptoms. At an August 31, 1998 visit, Claimant complained of right shoulder pain. Dr. Adee diagnosed acromioclavicular arthritis secondary to chest and shoulder myofascial pain. 


   14. In June of 1999, Claimant saw Dr. Reusing for, among other things, right elbow pain. Dr. Reusing attributed the symptoms to playing golf. 


   15. In October of 1999, Claimant treated with Dr. Adee for left back pain and left leg pain after lifting laundry. Dr. Adee diagnosed lumbosacral strain with sciatica. 


   16. In November of 1999, Claimant followed up with Dr. Adee. At this visit, she complained of pain down the right calf and shooting pains and weakness in all extremities, worse on the right than left, and worse at night. Dr. Adee's impression was  fibromyalgia versus somatoform  disorder, possible vertebral basilar insufficiency, as well as hypertension, anxiety, and depression. Dr. Adee referred Claimant to Dr. Shelley Ham, a psychiatrist. 


   17. On December 17, 1999, Dr. Adee saw Claimant for follow-up for her fibromyalgia syndrome, depression, and questionable social phobia. Dr. Adee reported that Claimant was handling work stress a little better. Dr. Adee instructed Claimant to refer herself to Dr. Pillai to evaluate her "possibly work-related" complaint of increasing right-sided weakness.


 Medical Treatment from 7/7/00 


   18. On July 7, 2000, Claimant saw Dr. Ruesing for exhaustion, periodic panic attacks, neck pain, and a funny feeling in the right shoulder going down to the right leg. Claimant wondered whether she had a stroke. Dr. Ruesing referred Claimant to Dr. Pillai for a neurologic consultation. There was nothing in Dr. Ruesing's chart notes to indicate that Claimant's symptoms on this date were related to her work. 


   19. On August 16, 2000, Claimant saw Dr. Pillai. At this visit, Claimant told Dr. Pillai that she has had neck and back pain since the beginning of the year. She complained of neck pain that radiated into the right upper extremity, and back pain that radiated into the right lower extremity. Dr. Pillai diagnosed cervical strain and lumbosacral strain with probably right lumbosacral radiculopathy, depressive disorder, and insomnia. There was no indication from Dr. Pillai's chart notes or report that Claimant's symptoms were related to her work. 


   20. On August 27, 2000, Claimant underwent an MRI scan of the lumbar spine. The scan showed minimal encroachment upon the central canal at L4-5 with slight posterior annular bulging at L3-4 and L4-5, but was otherwise considered normal. There was no evidence of advanced central stenosis or neural impingement. 


   21. On September 13, 2000, Claimant returned to Dr. Pillai for complaints of severe pain on the right side of the neck and right arm. Dr. Pillai noted that Claimant was quite emotional and teary-eyed. 


   22. On September 17, 2000, Claimant underwent an MRI scan of the cervical spine. The results were interpreted as normal. 


   23. Claimant underwent physical therapy and consulted with Dr. Terry Smith, an orthopedic surgeon. Dr. Smith recommended epidural blocks. 


   24. Upon referral by Dr. Pillai, Claimant received a series of epidural blocks from Dr. Greg Ruhland. Claimant experienced no significant or lasting improvement from the injections. 


   25. On January 17, 2001, Dr. Pillai conducted nerve conduction and EMG testing on Claimant's right upper and lower extremity. The results were within normal limits for the right upper extremity. The results for the right lower extremity were within normal variance, but, according to Dr. Pillai, they could also be consistent with lumbosacral radiculopathy. 


   26. On May 8, 2001, Claimant was evaluated by Dr. Lome Direnfeld, a neurologist. At the evaluation, Claimant's primary complaints included low back pain that radiated to the pelvis and right calf, back and leg pain, tightness on the right side of the neck, and abnormal sensation in the medial two digits of the right hand. Claimant told Dr. Direnfeld that she used to have right sided pain from the neck down to the right arm and into the two medial digits of the right hand, but that pain was no longer present. 


   Dr. Direnfeld reviewed Claimant's x-rays, August 27, 2000 MRI scan of the lumbar spine, and September 17, 2000 MRI scan of the cervical spine. He confirmed that these tests showed no significant abnormality.


   Dr. Direnfeld opined that Claimant's low back and leg complaints were consistent with chronic lumbosacral strain and right SI radiculopathy due to possible right L5-S1 disc herniation. Clinically, however, Claimant did not exhibit signs of significant radiculopathy as her neurological examinations have been negative, and her MRI scan of the lumbar spine showed no pathology that could account for any right SI nerve root impingement. Dr. Direnfeld stated that Claimant could possibly have a chemical irritation of that nerve root. 


   As for Claimant's upper extremity symptoms in the two fingers of the right hand, Dr. Direnfeld gave her a number of differential diagnoses that included ulnar neuropathy, cervical radiculopathy, and non-specific thoracic outlet syndrome. Dr. Direnfeld noted, however, that the record contains no clinical findings to support a diagnosis of any of these conditions. According to Dr. Direnfeld, the MRI of the cervical spine was normal and showed no evidence of structural abnormality of the neck that could account for Claimant's sensory deficits in the fingers of the right hand. 


   Dr. Direnfeld opined that based on his review of the medical records, he found nothing  in the record to relate Claimant's low back, neck, and upper and lower extremity complaints to her work as a dispatcher, within a reasonable medical probability. Dr. Direnfeld noted that Claimant had a lengthy history of musculoskeletal complaints dating back to at least 1995, and there was nothing from Claimant or her doctors that suggested that her work was causing or contributing to her musculoskeletal symptoms. Furthermore, diagnostic testing such as MRI scans of the lumbar and cervical spine have not yielded any clinical findings that would account for Claimant's symptom complex. 


   27. The record contains no medical evidence to show that Claimant's cervical and lumbosacral conditions were caused or aggravated by cumulative and repetitive movements while performing her job as a dispatcher. 


   Dr. Pillai, who treated Claimant, was aware of Claimant's claim for workers compensation, but he did not provide any opinions or report to support her claim that Claimant's lumbosacral and cervical strains were due to her work as a police dispatcher over the years. 


   Dr. Ruesing, who noted in her record that Claimant had filed a claim for C3-4 and L4-5 disc bulges, also did not provide any opinions relating Claimant's musculoskeletal complaints to her job. 


   Dr. Adee's instruction to Claimant to see Dr. Pillai for evaluation of her right-sided weakness that may "possibly" be related to work was not, in our view, a medical opinion rendered within reasonable medical probability that Claimant's physical movements at work over the years caused or aggravated her physical conditions to the neck and back. It appeared to be more of a recommendation by Dr. Adee that Claimant have Dr. Pillai evaluate the possible work-relatedness of her right-sided complaint. 


   Dr. Ham treated Claimant for a psychiatric condition, but did not provide any reports to support her claim for physical injuries. 


   28. Given Claimant's history of musculoskeletal complaints dating back to at least 1995, the absence of medical evidence from any of her treating physicians to support her claim that repetitive movements at work caused or contributed to her physical symptoms, and the credible and persuasive opinions of Dr. Direnfeld, we find that Employer has presented substantial evidence to overcome the presumption of compensability.


Conclusions of Law 


   Based on the foregoing, we conclude that Claimant did not sustain a personal injury on July 7, 2000, arising out of and in the course of employment.




   The decision of the Director, dated July 3, 2001, is affirmed, in accordance with the foregoing. 


   Dated: Honolulu, Hawaii, Jan. 22 2003.