Source: http://wcc.dli.mt.gov/B/RB_Findings.htm
Timestamp: 2019-04-21 14:50:17+00:00

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Summary: Insurer (State Fund) petitioned for approval to terminate claimant's benefits for non-compliance with medical recommendations. Evidence presented at trial indicated that claimant, who suffered initial foot injuries which ultimately required partial amputation of her right leg, has failed to follow medical advice and has harmed herself by (1) gaining significant weight (ballooning from 350 pounds to 454 pounds), (2) chewing her fingers despite repeated infections which led to partial amputation of seven fingers, (3) removing bandages from her fingers, (4) attempting to remove IV (intravenous) lines, (5) refusing a necessary IV line until threatened with involuntary mental commitment, (6) refusing x-rays, and (7) refusing infectious care precautions. Dr. Bill Rosen, a specialist in physical and rehabilitation medicine, recommended comprehensive, multi-disciplinary treatment of claimant in Billings, Montana. The treatment team would include a psychiatrist, psychologist, neurologist, pulmonologist, bariatric (weight control) specialist, orthopedic surgeon, and prosthetist (specializing in prosthetics). The treatment regime and specialists recommended by Dr. Rosen are not available in Miles City, Montana, where claimant resides and where she has been residing in a skilled care nursing home for the past two years. Therefore, Dr. Rosen recommended she be transferred to Billings. Claimant refused the recommendation: she insists on staying in Miles City and continuing to treat with Dr. Susan Gallo, a family practitioner who has been claimant's treating physician over the past two and one half (2½) years, even though she has not followed Dr. Gallo's medical advice on many occasions. Dr. Tom Peterson, a psychologist who treated claimant for a few months and was then discharged by claimant, testified that claimant is suffering from mental illness which renders her incapable of making reasoned and rational decisions concerning her own medical care. However, since Dr. Peterson and Dr. Rosen last saw claimant, she has made remarkable improvement, including weight loss of almost a hundred pounds and cessation of her finger biting. At the time of trial on December 3, 2002, Dr. Gallo planned to discharge claimant from the nursing home and testified that it is in claimant's best medical interests for her to remain in Miles City and continue her treatment there. Dr. Gallo has and will continue to involve specialists in claimant's care.
Held: The claimant is presently cooperating in the medical care prescribed by her treating physician and is making good progress. The Court is persuaded she is presently competent to make rational and reasoned judgments concerning her own medical care and that it is presently in her best interests to continue treating with Dr. Gallo in Miles City. The petition to terminate benefits is therefore denied. However, in light of claimant's history of non-compliance with medical advice, the denial is without prejudice to the State Fund renewing its request should claimant in the future engage in self-destructive conduct or refuses appropriate medical treatment. The Court retains jurisdiction to consider a renewed request in the event the claimant fails to comply with medical advice in the future.
Claimants: Duties: Medical Advice. As a general matter, a claimant has a duty to follow medical advice so as to diminish the effects of her injury and minimize disability.
Claimants: Duties: Medical Advice. Section 39-71-1106, MCA (1995), permits an insurer to terminate compensation benefits where a claimant unreasonably refuses medical treatment recommended by a managed care organization or treating physician. The section does not authorize termination of benefits for refusal to submit to treatment recommended by an independent medical examiner.
Constitutions, Statutes, Regulations, and Rules: Montana Code Annotated: 39-71-1106 (1995). Section 39-71-1106, MCA (1995), permits an insurer to terminate compensation benefits where a claimant unreasonably refuses medical treatment recommended by a managed care organization or treating physician. The section does not authorize termination of benefits for refusal to submit to treatment recommended by an independent medical examiner.
Claimants: Duties: Medical Advice. In addition to the authority to terminate benefits under section 39-71-1106, MCA (1995), for non-compliance with treatment recommendations of a managed care organization or treating physician, an insurer may terminate benefits where a claimant refuses reasonable medical treatment which would improve claimant's condition and disability. Dosen V. East Butte Copper Mining Co., 78 Mont. 579, 254 P.880 (1927).
Cases Discussed: Dosen v. East Butte Copper Mining Co., 78 Mont. 579, 254 P.880 (1927). In addition to the authority to terminate benefits under section 39-71-1106, MCA (1995), for non-compliance with treatment recommendations of a managed care organization or treating physician, an insurer may terminate benefits where claimant refuses reasonable medical treatment which would improve claimant's condition and disability.
Claimants: Duties: Medical Advice. In determining whether a claimant's refusal of medical treatment is reasonable, the Court must consider "a multitude of variables," including claimant's psychological condition. Small v. Combustion Engineering, 209 Mont. 387, 681 P.2d 1081 (1984).
Cases Discussed: Small v. Combustion Engineering, 209 Mont. 387, 681 P.2d 1081 (1984). In determining whether a claimant's refusal of medical treatment is reasonable, the Court must consider "a multitude of variables," including claimant's psychological condition.
Claimants: Duties: Medical Advice. If a claimant is mentally capable to make rational and reasoned decisions concerning claimant's medical care but disregards medical advice and engages in conduct which undermines claimant's medical care, the insurer may be justified in terminating benefits.
Claimants: Duties: Medical Advice. If a claimant is mentally incapable of making rational and reasoned decisions regarding her medical care, an insurer cannot terminate benefits for the claimant's failure to follow medical advice, however, where the matter is brought to the attention of the Workers' Compensation Court, the Court will refer the matter to State authorities empowered to bring proceedings to protect the claimant.
¶1 The trial in this matter began on December 3, 2002, in Billings, Montana. It continued in Miles City, Montana on December 4, 2002. Respondent, R.B. (claimant), was represented by Mr. R. Russell Plath. Claimant was not present during the Billings portion of the trial but was personally present during the proceedings in Miles City. Petitioner/Insurer, Montana State Fund, was represented by Mr. Greg E. Overturf and Mr. Thomas E. Martello.
¶2 Exhibits: Exhibits 1 through 63 were admitted without objection. Exhibit 64 was provided post-trial.
¶3 Witnesses: Claimant, Dr. Bill Rosen, Tom Peterson Ed.D., and Dr. Susan Gallo testified at trial.
¶4 Issue Presented: This case was specially set. No pretrial order was filed, however, the parties were in agreement as to the issues and both filed trial briefs. The issue presented is whether the State Fund is entitled to suspend benefits on account of claimant's alleged failure to cooperate in her own medical care.
¶5 Having considered the testimony presented at trial, the demeanor and credibility of the witnesses, the exhibits, and the arguments of the parties, the Court entered an oral bench ruling at the conclusion of trial. A transcript of that ruling is attached as an addendum to this decision. The following, written findings of fact, conclusions of law incorporate and expand upon the bench ruling and constitute the Court's final findings of fact, conclusions of law and judgment.
¶6 Claimant has resided in Miles City, Montana all of her life. Her family and friends are in Miles City and she wishes to remain there. I begin this decision with this statement because it is a primary reason claimant has refused recommendations that she be cared for in Billings, Montana. Moreover, the claimant's connection to Miles City has provided her recent motivation to co-operate in her medical care.
¶8 At the time of the injury, the claimant's employer was insured by the State Fund. The State Fund accepted liability for her injury and has paid medical and compensation benefits. It continues paying medical and compensation benefits.
¶9 Since claimant's injury she has had multiple medical complications. Liability for those complications is not at issue but the complications give rise to the present controversy.
¶12 By July 2, 1996, claimant was "mainly restricted to a wheelchair." (Ex. 30 at 1.) On that date, Dr. Elliott diagnosed a left ankle "fracture . . . with subsequent avascular necrosis [dead bone] and collapse" and probably "peripheral neuropathy, bilateral feet." (Id. at 2.) He recommended surgery.
¶14 The fusion was slow in taking. (Ex. 5 at 19 et seq.) Meanwhile, claimant developed cellulitis in both of her lower legs. (Ex. 5 at 21-22, 25-30, 40.) "Cellulitis" is a generic term for inflammation of connective tissue, Merriam-Webster Medical Dictionary, which can be from infection.
¶15 By April 27, 1999, claimant's right ankle had collapsed "with talar avascular necrosis." (Id. at 32.) On that date, Dr. Whitney S. Robinson noted that claimant also had an infected finger. The finger infection was one of many which followed.
¶16 In addition to Dr. Susan Gallo, claimant has been treated by numerous other physicians, but Dr. Gallo has remained her primary care physician.
¶18 Following amputation of claimant's right leg, claimant was admitted to Holy Rosary Extended Care Facility in Miles City, Montana. The facility is a nursing home providing 24-hour skilled medical care. It is attached to the hospital in Miles City.
¶20A Claimant was significantly obese at the time of her injury. On June 2, 1996, she was reported as weighing 350 pounds. See ¶ 10. On May 8, 2001, her weight was 368 pounds. (Ex. 28 at 28.) Over the next 16 months, she gained almost 100 pounds; by September 2002, she weighed 454 pounds. For much of her nursing home stay, she refused dietary advice, refused to be weighed, and had food from outside the nursing home brought to her. (See, e.g., Ex. 23 at 183, where the nursing staff at the nursing home recorded that on May 31, 2002, the claimant brought in four (4) cases of coke, six (6) packages of cookies, and twenty-four (24) bags of licorice.) Claimant's weight gain resulted in compromise of her cardiovascular efficiency and she had to be put on regular oxygen. She continues to require oxygen.
¶20C Nurses' notes during the claimant's extended stay at the nursing home suggest that on several occasions claimant removed bandages from her fingers, chewed on her sutures, and removed IV lines. (Ex. 23 at 23, 24, 35, 48, 65, 125.) A good history of these events is set out in Dr. Peterson's June 28, 2002 report, which is found at Exhibit 11, beginning at page 4.
I also talked to her about the possibility that due to her poor judgment and refusing the treatment, we may need to seek an involuntary commitment to a psychiatric unit to have her further evaluated regarding her obsessive-compulsive disorder, her borderline personality disorder and depression.
Patient reported that the gloves don't fit, and that they were too tight across her hand. She stated she wouldn't be able to do anything with the gloves on. She said she wouldn't wear them. . . .
. . . She reports that they would not allow her to do her functional activities, and she expected a very thin fabric. She stated they were too thick, and she couldn't feel her hands. She stated she was not going to wear them. . . .
In a most pronounced fashion she chews her fingernails. She has chewed most of her fingers to the point where the fingernail is gone and she is chewing on the flesh. In recent times she developed a very serious infection on her left hand middle finger. She was operated on by Dr. Brooks, orthopedic surgeon. She is currently taking massive antibiotics. Home health comes to her house twice a day to treat the infection. She continues to bite her fingernails and/or the flesh.
¶22 Claimant continued seeing Dr. Peterson until April 10, 2001. Most of his visits with claimant were in Miles City, where Dr. Peterson worked under contract with the Mental Health Center serving Miles City. However, he also saw claimant in Billings in January 2001, when her leg was amputated. (Ex. 57 at 5-6). Dr. Peterson was in Miles City one day every week, but testified that he saw claimant only every other week and that he did not always see claimant as scheduled.
I also suspect that she has many inner conflicts about her own independence versus her dependency needs. It almost appears as if she is increasing her dependency status by aggravating/perpetuating her physical disability. One of the primary ways in which she is aggravating her disability is by causing damage to her fingers. . . .
This patient would do best if managed at a local nursing home in Billings. She will need to see a variety of providers. At a minimum, I would imagine that she would benefit from neurology, psychiatry, psychology, rehab, ortho, pulmonary, bariatric, prosthetic and primary care. Her neuropathy has never been worked up and this condition needs to be evaluated fully and then possible treatment for this, if treatable, as well as treatment for her neuropathic pain can be pursued. In addition, I would recommend an evaluation by a pulmonologist to maximally optimize her pulmonary care and also care related to her obesity could be provided by an internist or bariatric specialist. Orthopedic and rehabilitation issues could be addressed by her current orthopedist, Dr. Whitney Robinson, and myself. General medical issues could be provided for by her attending physician at a local nursing home. I will discuss her case with both her attorney, Russ Plath, as well as Patricia Boege. I believe that this patients only hope of an improved medical quality of life is to move from Miles City to Billings where multiple specialists can participate in her care needs. Most significantly, we will need to provide her with the care of a psychiatrist and psychologist. At any rate, I will be discussing her case in the near future with Patricia Boege and present her with these recommendations. I did discuss these as well with Ms. R.B. and she had virtually no interest whatsoever in moving to Billings at this time. Hopefully, she can be persuaded otherwise.
Axis 1 312.30 Impulse Control Disorder, NOS-Repetitive Self-Mutilation Disorder (Deliberate Self Harm, Self Injurious Behavior or Para-Suicidal Behavior). This diagnostic impression is broadly defined as a repeated, direct destruction of body tissue without suicidal intent. It involves the recurrent failure to resist impulses to harm ones body physically and directly without conscious suicidal intent. Such impulses are thought to be associated with increasing tension, anxiety and anger or other dysphoric states. The self mutilating behavior appears to prompt relief of the uncomfortable feelings shortly after the acts of self harm. The act of self harm is often associated with the lack of pain and performed secretly.
Repetitive Self-Mutilation often co-occurs with other Axis I and 11 psychiatric disorders such as: mood substance abuse, eating and borderline personality disorders.
296.90 Mood Disorder NOS - This examiner is impressed the patient may be experiencing a mood disorder of the bipolar type. Her history is suggestive of mood lability and thought disruption not uncommon to major mood disorder. Family history is supportive of this possibility.
307.89 Pain Disorder Associated with Both Psychological Factors and Medical Conditions.
¶27 Both Dr. Rosen and Dr. Peterson testified at trial. Dr. Rosen testified that claimant needs specialized medical treatment not available in Miles City. He recommended that she be evaluated and treated by a neurologist, a pulmonologist, a bariatric (weight control) specialist, a psychologist, a psychiatrist, an orthopedic surgeon, and a prosthetist (specializing in prosthetics). Many of the services she needs are available in Billings but Dr. Rosen noted that a comprehensive treatment program will have to be pieced together and that no ideal program suitable for claimant exists anywhere in the United States. He noted that the biggest problem in finding claimant appropriate care is the lack of adequate psychiatric services in Montana.
¶28 Dr. Rosen was unable to determine if the claimant has the mental capacity to determine what is best for herself with respect to her medical care.
¶29 When questioned whether it would be in claimant's best interest to remain in Miles City if she lost significant weight (60 pounds), controlled her finger biting and weaned herself from antibiotics, and was scheduled for discharge at Christmas by her primary physician, Dr. Rosen agreed that if she could remain independent and is mentally competent, then she should be allowed to make that choice.
¶31 As noted above, Dr. Rosen saw claimant in April 2002. Dr. Peterson last saw claimant in June 2002. Between June 2002 and the time of trial, claimant's circumstances changed dramatically. First, she has complied with dietary recommendations. As a result, her weight dropped from 464 pounds in September 2002 to 397 pounds on November 29, 2002, a remarkable reduction of 67 pounds. Second, her finger biting has subsided. She is off antibiotics and her most recent amputations were almost healed. Her need for oxygen is declining. She walked across the hall to the room where she testified, showing that she is improving in her ambulation. She expressed willingness to submit to psychological treatment.
¶32 Claimant's improvement has been remarkable to the point that Dr. Gallo expected to discharge her from the nursing home and into an independent living apartment at Christmas time. Indeed, in a conference call with counsel approximately two weeks ago, claimant's attorney confirmed that she was discharged as planned and is living in her own apartment.
¶33 Claimant testified at trial that she intends to comply with medical advice and continue to lose weight. She wishes to remain in Miles City and intends to live independently.
¶34 Dr. Gallo, a family physician, has been claimant's treating physician since May 22, 2000. (Ex. 28 at 1.) Dr. Gallo testified at trial and impressed me as a caring physician who has only claimant's best interests in mind. The physician-patient relationship she has with the claimant is especially strong. She supports claimant's wish to remain in Miles City and continue her treatment there. She has already involved many specialists in claimant's treatment and will continue to do so. She acknowledged the need for psychiatric and psychological care and is attempting to find appropriate specialists.
¶35 I find as a matter of fact that claimant is currently competent to make decisions regarding her medical treatment and is complying with medical advice. Her history, however, causes me grave concern as to whether she will continue to comply with medical advice and continue to improve.
¶36 This case is governed by the 1995 version of the Montana Workers' Compensation Act since that was the law in effect at the time of the claimant's industrial accident. Buckman v. Montana Deaconess Hospital, 224 Mont. 318, 321, 730 P.2d 380, 382 (1986).
39-71-1106. Compliance with medical treatment required -- termination of compensation benefits for noncompliance.
¶38 On its face, section 39-71-1106, MCA, authorizes termination of benefits only if claimant fails to cooperate with a managed care organization or cooperate with and follow her treating physician's medical recommendations. In this case, there is no indication that Dr. Rosen and Dr. Peterson are part of a managed care organization responsible for claimant's treatment. They are also not treating physicians, therefore, there is no basis under subsection (1) for terminating her benefits because of her refusal to comply with Dr. Rosen's and Dr. Peterson's recommendations.
¶39 However, under section (2), the State Fund is entitled to stop benefits if claimant does not comply with her treating physician's recommendations. While the section provides termination of benefits upon a 14-day notice, the State Fund sought a declaratory judgment allowing termination rather than unilaterally terminating benefits as allowed by the section. The Court lauds its decision to do so under the circumstances of this case. During the pendency of this proceeding, the State Fund has continued to pay benefits, thus alleviating any hardship on claimant that would have resulted from a unilateral decision to terminate benefits. By seeking a Court determination, the State Fund acted reasonably to obtain an impartial determination as to whether it would be justified in cutting off benefits.
¶40 Under subsection (2), an insurer may cut off benefits if the claimant fails "to submit to medical treatment recommended by the treating physician, except for invasive procedures." Dr. Rosen saw claimant at the specific request of the State Fund, hence his role is that of an independent medical examiner, not a treating physician. While Dr. Peterson did act as a treating psychologist for a time, claimant discharged him long ago. His involvement in this case is at the request of the State Fund, which requested that he re-examine claimant. As with Dr. Rosen, his role is that of an independent examiner.
¶41 The treating physician in this case is Dr. Gallo. Therefore, it is her medical recommendations that I have to consider under section 39-71-1106, MCA. In doing so, it is clear that in the past the claimant has refused to follow some of Dr. Gallo's recommendations. She refused Dr. Gallo's recommendations for further psychological treatment and for weight loss. She also resisted treatment of her fingers and continued to chew her fingers, leading to further infections. Claimant's conduct may very well give rise to grounds to terminate benefits. However, it is also clear that at present the claimant is complying with Dr. Gallo's medical recommendations.
¶42 In addition to section 39-71-1106, MCA, there is case authority for terminating benefits when claimants refuse reasonable medical treatment which would improve their condition and reduce disability.
¶43 In Dosen v. East Butte Copper Mining Co., 78 Mont. 579, 254 P. 880 (1927), the Montana Supreme Court held that an insurer is absolved from paying compensation where the claimant refused medical treatment recommended by his physicians. The claimant in that case suffered from osteomyelitis (a bacterial infection of the bone) and his physicians recommended amputation. He refused and pursued a claim for permanent total disability (PTD). His request for PTD was granted by a district court but on appeal the Supreme Court reversed, holding that the claimant's refusal to submit to a reasonable medical procedure absolved the insurer of liability. 254 P. at 888-89.
"Notwithstanding the fact that the osteomyelitis in his leg will continue, eventually causing the loss of his leg, and possibly his life, claimant always has stubbornly refused to submit to amputation, although little danger is to be apprehended from the operation . . . . The board could not order claimant to submit to amputation of the leg, but it could absolve the company from making the payments during the period of claimant's obstinate and unreasonable refusal to submit to the operation advised by the surgeons in this case." 78 Mont. at 606, 254 P. at 888.
That rule was the subject of further discussion in Small v. Combustion Engineering, 209 Mont. 387, 681 P.2d 1081 (1984). In that case the Court overruled Dosen but only to the extent that it failed to consider whether a claimant's refusal to follow his physician's recommendation was reasonable 'in light of the "multitude of variables" appropriate to this complex factual determination . . . .' 209 Mont. at 394, 681 P.2d at 1084. In Small the claimant suffered from a manic-depressive disorder that affected his ability to make a decision regarding surgery. While not overruling the rule that a failure to comply with reasonable medical recommendations relieves the insurer from liability, the Court in Small held that in determining the reasonableness of a claimant's refusal to submit to medical care the Court must take into consideration the "claimant's manic-depressive disorder and its effect upon his ability to make a decision regarding surgery." Id.
¶45 Dosen did not consider whether the medical recommendations had to be from the claimant's treating physician. Putting that question aside, in this case there is ample evidence that the claimant's mental capacity to make decisions regarding her medical care was diminished and, at times, lacking altogether. Under Small diminished capacity would preclude the insurer from terminating benefits even though the recommended care is in claimant's best interest and even though her refusal of that care may lead to her premature death.
¶46 On the other hand, if in fact the claimant is mentally incapable of making reasonable determinations regarding her medical care, she may, as suggested by Dr. Peterson, be in need of a medical guardian or even commitment to a mental health facility. In view of the fact that her past conduct may amount to suicide by increments, a substantial question arises as to whether she is mentally capable of making reasoned and rational decisions concerning her own medical care. If she is not capable of making reasoned and rational decisions regarding her own medical care, then her mental condition may require State intervention. In such case, I would be required to refer the matter to the county attorney and other state authorities authorized to initiate proceedings to protect the claimant . This Court has no authority to appoint a medical guardian or order claimant to submit to specific medical procedures. The Workers' Compensation Court's authority is limited to determining whether claimant is entitled to benefits.
¶47 In the future, claimant must follow her treating physician's advice unless she can demonstrate that it is reasonable for her not to do so, as discussed above, or that she is mentally incapable of making reasoned and rational decisions concerning her own medical care. Her failure to comply with reasonable treatment recommendations may lead to termination of her benefits if she is competent to make reasoned and rational decisions regarding her own medical care.
¶48 The State Fund's request that it be allowed to terminate the claimant's benefits is denied for the reasons set forth above. The denial is without prejudice to the State Fund renewing its request in the event the claimant fails in the future to comply with treatment recommendations of Dr. Gallo or other treating physician.
¶49 Henceforth, the claimant must comply with Dr. Gallo's treatment recommendations or risk termination of her benefits or referral to State authorities authorized to initiate protective proceedings.
¶50 In light of the history of claimant's non-compliance with the medical recommendations of her treating physician, the Court retains jurisdiction to review the State Fund's request anew in the event that the claimant fails to comply with Dr. Gallo's recommendations in the future. If claimant fails to comply with Dr. Gallo's recommendations, and the evidence indicates she is mentally incapable of making reasoned decisions concerning her medical care, then the Court will refer the matter to the State authorities statutorily empowered to bring proceedings to protect claimant.
¶51 Claimant is entitled to her costs and shall file her memorandum of costs in accordance with Court rules.
¶52 The claimant's attorney successfully preserved the claimant's entitlement to benefits and is entitled to attorney fees out of the claimant's future benefits. Pursuant to his fee agreement with the claimant, which was filed post-trial, he is entitled to 25% of those future benefits. Therefore, the State Fund shall make future payments of 25% of compensation benefits to claimant's attorney and 75% of those benefits to claimant. The payments shall be made separately and sole-payee with respect to those amounts.
¶53 This JUDGMENT is certified as final for purposes of appeal.
¶54 Any party to this dispute may have twenty days in which to request a rehearing from these Findings of Fact, Conclusions of Law and Judgment.
17 THE WITNESS: Yes, I will.
19 everything that your doctor is recommending?
20 THE WITNESS: Yes, I will.
24 go from here. Let's take five minutes.
6 records a lot, and so I know how to read them.
11 than what questions I ask you.
15 matter -- I have what I call limited jurisdiction.
16 I can only determine matters involving benefits.
25 past you haven't cooperated in your care.
17 voluntary choice in those sorts of things.
20 contributes to that and that makes it much harder.
23 anxious. These situations are very very difficult.
4 then I have the authority to cut the benefits off.
8 my jurisdiction and then it becomes a State matter.
14 you have quite a lot of problems.
20 decisional competency to make voluntary decisions.
24 explained to you what those consequences are.
8 you understand what I'm saying?
21 going to supervise it.
2 whether or not at that point you're cooperating.
13 THE COURT: So, it's essential.
15 cooperate with Dr. Gallo and get better.
17 THE COURT: Do you understand all that?
18 THE WITNESS: You bet.
19 THE COURT: Do you have any questions?
21 September when I did have that hospital stay.
22 THE COURT: It scared you?
4 look more healthier. So, I'm feeling a lot better.
10 continue that, that you not relapse.
15 itself is going to help.
16 THE WITNESS: Yes, I agree.
17 THE COURT: Okay. All right. Russ.
17 just asking for their help to put that together.
19 together so I'm just asking them to help me do that.
20 That will take a little time before we get that out.
23 to get better, okay?
24 THE WITNESS: I will.
25 THE COURT: Okay. Anything else?
1 MR. PLATH: Nothing further.
2 MR. OVERTURF: Thank you, Judge.
17 result of the within action.
1. "Peripheral neuropathy" is "a disease or degenerative state (as polyneuropathy) of the peripheral nerves in which motor, sensory, or vasomotor nerve fibers may be affected and which is marked by muscle weakness and atrophy, pain, and numbness." Merriam-Webster Medical Dictionary. In claimant it is manifested by neuropathic (nerve type) pain.

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