Opinion ID: 2821415
Heading Depth: 3
Heading Rank: 2

Heading: Shaw’s STD Benefits

Text: Shaw suffered from chronic neck pain for years. On August 12, 2009, Sedgwick contacted Shaw about his absence from work and informed him that he might be eligible for STD benefits. To qualify, Sedgwick told Shaw to submit medical documentation demonstrating that his illness or injury “prevents [him] from performing the duties of [his] job with or without reasonable accommodations.” (R. 15-1, PageID 708.) After “a thorough review” of Shaw’s medical documentation, Sedgwick notified Shaw on September 17, 2009, that his STD benefits claim had been approved retroactively to August 7, 2009. Over the course of the next year, Sedgwick conducted various reviews and reapproved Shaw’s STD benefits claim on numerous occasions. Throughout his time receiving STD benefits, Shaw was treated by Dr. Laura Reincke, a family-medicine practitioner. Dr. Reincke ordered cervical epidural steroid injections to manage No. 14-2224 Shaw v. AT&T Umbrella Plan Page 4 his pain. According to Dr. Reincke, these injections helped, but Shaw was “still getting neck pain.” (R. 14-1, PageID 131.) In her medical charts, Dr. Reincke reported that Shaw was unable to drive longer than a half-hour and could “only sit for 20 min[utes]” due to his condition. (R. 14-3, PageID 262.) In November 2009, Dr. Reincke recommended that Shaw contact Dr. Neil Pasia, an orthopedic specialist, for further evaluation. Dr. Pasia examined Shaw in December 2009 and January 2010. On December 15, 2009, Dr. Pasia ordered an MRI of Shaw’s cervical spine. The MRI revealed a “herniated nucleus pulposus at C6/7 causing right foraminal stenosis” and a “right paracentral disc bulge with effacement of the thecal sac.” (R. 14-1, PageID 138.) A physical examination by Dr. Pasia also revealed “some paravertebral spasm at the base of the neck” and “limited range of motion with flexion, extension, rotation, and bending secondary to pain.” (Id.) However, the Spurling’s test1 result was negative. Dr. Pasia told Shaw that he may benefit from a cervical discectomy and fusion and that surgery “would allow him to increase his current level of activity including job functions and would decrease his pain medication intake.” (R. 14-2, PageID 140.) Dr. Pasia also informed Shaw of the risks of surgery, including “bleeding, infection, decreased or loss of motion, malunion, nonunion, need for further surgery, nerve damage, dural tear, paralysis, heart attack, and/or potential death.” (R. 14-1, PageID 137.) Shaw was evaluated further by Dr. Devon Hoover, a neurologist. On May 28, 2010, Dr. Hoover found that Shaw had “neuroforaminal narrowing at C5-6 and C6-7.” (R. 14-4, PageID 325.) Dr. Hoover opined, “[t]hough the symptoms seem a bit pronounced for the MRI findings, I do believe the MRI likely explains the pain. . . . I do feel that he would be a candidate for a C5-6 and C6-7 anterior cervical discectomy and fusion. . . . At this point, he wants to do physical therapy and we will see him back in a couple of months to reassess.” (Id.) While receiving STD benefits, Shaw was also treated by Dr. Pasia’s colleague, Dr. Matthew Sciotti. On June 30, 2010, Dr. Sciotti examined Shaw. His physical examination revealed “reduced range of motion” and “slight pain to palpation over the cervical paraspinal 1 Physicians conduct a Spurling’s test to assess nerve root compression and cervical radiculopathy by turning the patient’s head and applying downward pressure. A positive Spurling’s sign indicates that the neck pain radiates to the area of the body connected to the affected nerve. Spurling’s Test, Physiopedia.com, http://www.physio-pedia.com/Spurling’s_Test (last visited July 12, 2015). No. 14-2224 Shaw v. AT&T Umbrella Plan Page 5 muscles.” (Id. at 353.) The “Spurlings [were] negative bilaterally.” (Id.) Dr. Sciotti also performed an electromyography (“EMG”), with a nerve conduction study to test the electrical activity of Shaw’s muscles. The EMG revealed “few spontaneous waveforms in the right triceps and cervical paraspinal muscles.” (Id. at 352.) Dr. Sciotti referred Shaw to the Matrix Pain Management Clinic. In June and July of 2010, Shaw saw a physical therapist, Dr. Sandy Payne. Shaw reported he was “having less pain [and] more freedom of [movement] after treatment.” (R. 14-3, PageID 237.) However, he demonstrated “a very low tolerance for light exercise and minimal head movement with . . . increased pain.” (Id.) He also did not “demonstrate the tolerance for progression of manual techniques or exercise due to reported pain.” (Id. at 241.) Shaw had significant range-of-motion limitations, such as a cervical flexion of two degrees, an extension of 10 degrees, and a lateral flexion of 10 degrees. (Id. at 234.) Additionally, Dr. Payne reported that Shaw had significant functional limitations, such as an inability to stand for more than 30 minutes, walk for more than 10 minutes, and lift more than 10 pounds with his left hand. (Id. at 235.) In July 2010, Shaw also visited the Matrix Pain Management Clinic and was evaluated by Dr. Diane Czuk-Smith, an anesthesiologist. Shaw reported “[t]he pain interfere[d] with his daily activities always” and “[h]is sleeping pattern [was] poor, sleeping about 3 hours maximum, waking up with the pain.” (R. 14-7, PageID 491.) Further, a physical examination showed “spinous process tenderness C2 through 7 and T4 through 6,” “left facet tenderness C3 through T5 and right C3 through 7,” and “suprascapular and upper trapezius muscle spasm.” (Id. at 493.) Shaw’s range of motion from the neck was “positive at approximately 10 degrees flexion and extension.” (Id.) Shaw exhibited “extremely limited” head turning causing “significant pain.” (Id.)