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Missouri: Commission Finds Conversion Disorder Flows From Carpal Tunnel

November 19, 2015 (2 min read)

The commission affirmed an award of permanent and total disability benefits to a 38-year old woman who she states after a carpal tunnel surgery she was unable to use her arms or legs.  Law-Clark  v McCleod, 2015 Mo WCLR Lexis 105 (Nov. 6, 2015).

Shortly after she had carpal tunnel surgery, she began to describe bizarre symptoms with her hands clenching.  Over the course of several years, her symptoms became worse  and spread to her arms and legs.  She claims she can barely walk and she has difficulty cutting her own food and needs home nursing 6 hours a day.

A pain specialist  performed a series of spinal blocks for “migratory” RSD and he implanted  a spinal cord stimulator.  The doctor conceded some of the clinical findings did not support a diagnosis of RSD.

“She is mired in the diagnosis of CRPS/RSD” and has had “an incredibly long history of relatively unsuccessful treatment based on what may have been a misdiagnosis, ” according to ALJ Mahon.   The ALJ found her contention that she had RSD was inconsistent with multiple medical experts.  

The employee has a conversion disorder, according to the employer’s expert. The expert concluded the condition  was not substantially caused by the accident and was related to a personality defect.  Claimant assiduously denied psychological factors caused any of her symptoms.   A psychologist noted that claimant's family "appears to respond to the pain in a solicitous manner" and Claimant's pain problem appears to be "affected by psychosocial factors that could be addressed with psychological intervention.”  Claimant’s own expert also agreed she had a conversion disorder.  

The ALJ concluded that her  conversion disorder flows from stress and that since the symptoms came after her surgery then surgery was the "obvious"  cause of stress.  The commission affirmed the award for total disability and open medical to treat  her conversion disorder and major depressive disorder.  The ALJ denied benefits for the alleged RSD. Claimant denied she had other stressors in the past. The ALJ found she was found to be an unreliable witness.

The employer offered no vocational opinion to contest the finding that she was unemployable.  Claimant asserted that she was unsuccessful at an internet-based business.  The ALJ denied an award for home nursing services which was based on non-expert opinion.   The ALJ notes that after high school the claimant studied psychology.

Source: Martin Klug, Huck, Howe & Tobin. Read Martin Klug’s Mo. Workers’ Comp Alerts.

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