DECISION AND ORDER

American Home Assurance Corporation (Carrier) contested the decision of the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (the Commission) ordering reimbursement to____. (Claimant) for prescription medications purchased between June 18, 2003, and August 18, 2003. Carrier had denied reimbursementon the basis that the medication was not medically necessary to treat Claimant’s compensable injury.The Administrative Law Judge (ALJ) finds that while the medication was medically necessary to treat Claimant’s overall condition, it was not medically necessary to treat Claimant’s compensable injury. Therefore, Carrier isnot required to reimburse Claimant $179.60.^[1]

I. PROCEDURAL HISTORY

ALJ Sharon Cloninger convened and concluded the hearing onJune 10, 2004,in the William P. Clements Building, 300 West 15^th Street, Fourth Floor, Austin, Texas. Carrier was represented by Jim Korioth, attorney. Claimant appeared via telephone and was assisted by Juan Mireles, a Commission ombudsman, who appeared in person. The parties did not contest notice or jurisdiction, which are addressed in the Findings of Fact and Conclusions of Law below.

II. BACKGROUND

Claimant suffered a compensable injury on ___, when he was carrying a load of boxes on his shoulder and struck an overhead beam that drove him to his knees.^[2] Claimant’s initial diagnosis was cervical and lumbar sprain/strain. Prior to his compensable injury, Claimant underwent a two-level cervical fusion in September 1998. After his compensable injury occurred, he suffered a stroke in August 2000.

Claimant’s diagnosis as of ___, made by his treating doctor Kenneth L. Fults, D.O., was that he has a chronic, neurological deficit; myelomalacia^[3] of the spinal cord creating a gradual weakness of the lower extremities; and hyperreflexia^[4] of the patellar^[5] tendons with paresthesia^[6] in both arms and legs. Dr. Fults noted that Claimant ambulates with an antalgic^[7] gait, uses a four-point cane, and is getting weaker on a daily basis. He expected Claimant’s condition to deteriorate.

Since Claimant’s compensable injury occurred, he has undergone several MRI scans of the cervical spine, brain, thoracic spine, and lumbar spine. Further diagnostic studies have included X-rays, a cervical myelogram followed by CT scan, an EKG, and an MR angiography. Treatment for Claimant’s condition has included a cervical facet arthrogram injection, and oral medications including hydrocodone, methadone, Carisoprodol, Senna, Prevacid, and Effexor XR. Dr. Fults, who is a pain management specialist, has indicated Claimant requires pain control at an opiate level.

Claimant required medical therapy for pain control from June 18, 2003, through August 18, 2003, at a time when Carrier was no longer paying his claim, so purchased methadone for $34.45 on June 18, 2003, for $29.95 on July 21, 2003, and for $29.95 on August 18, 2003; Carisprodol for $21.25 on July 31, 2003; and hydrocodone for $63.00 on August 18, 2003, spending a total of $179.60.

Claimant’s request for reimbursement from Carrier for the medications he bought was denied. Claimant appealed Carrier’s denial before the Commission’s Medical Review Division (MRD). The MRD granted Claimant’s appeal following its review of adecision issued by an independent review organization (IRO)finding the treatment was reasonable and medically necessary.

III. APPLICABLE LAWAND ISSUE

A. Applicable Law

An employee who sustains a compensable injury is entitled to all health care reasonably required by the nature of the injury, as and when needed. The employee is specifically entitled to health care that: (1) cures or relieves the effects naturally resulting from the injury; (2) promotes recovery; or (3) enhances the ability to return to or retain employment. Tex. Lab. Code §408.021(a).

B. Issue

The sole issue in this matter is whether the disputed medication was medically necessary to treat Claimant’s compensable injury.Carrier argues that Claimant’s compensable injury was a contusion and sprain to his neck that should have resolved itself within a matter of weeks, and that Carrier should not reimburse Claimant for medication needed to treat his current condition, which is unrelated to his compensable injury. Claimant argues that Carrier should pay for the medication, because the ___, compensable injury aggravated a pre-existing injury to his neck, resulting in his current medical condition.

IV. EVIDENCE AND DISCUSSION

Claimant testified on his own behalf, and offered one exhibit, which was admitted.Carrier called one witness and offered two exhibits, which were admitted.

A. Claimant’s testimony

Claimant testified that his last treatment for the two-level cervical fusion occurred about a week before ___, when a box of boots fell on his neck at work, taking him to the ground. As part of his post-surgery rehabilitation, Claimant had been receiving physical therapy, taking medication, and walking three-to-four miles daily just prior to ___. He said the incident re-injured his neck, which has felt worse since then. He described living with “365 days of pain.” He said Chad Trimmell, M.D., is currently prescribing the same medication for him that Dr. Fults prescribed for him. He was not sure which doctor he was seeing from June 2003, through August 2003, during the disputed dates of service.

B. Testimony of Melissa Tonn, M.D.

Melissa Tonn, M.D., testified on behalf of Carrier that the disputed treatment was not reasonable or medically necessary, and pointed to her peer review as a summary of her opinion. (See “Documentary Evidence,” below.) She said her opinion is based on reasonable medical probability.

C. Documentary evidence

Medical records supporting Carrier’s position

a. Dr. Tonn

Dr. Tonn’s March 24, 2004, peer review states that Claimant’s compensable injury is limited to cervical contusion and sprain. In her opinion, based on the science of tissue injury and tissue healing, treatment under the claim should have been discontinued within eight-to-twelve weeks subsequent to July 7, 1999.

She explains that prior to July 7, 1999, Claimant was symptomatic from cervical spinal stenosis, having undergone a two-level C5-6, C6-7 cervical fusion with a concurrent diagnosis of severe myelopathy^[8] and/or myelomalacia. She said Claimant’s compensable injury does not include the diagnosis of cervical myelopathy and or/cervical myelomalacia.

Dr. Tonn also noted that Claimant suffered a left temporal stroke in August 2000,which affected his language, comprehension and speech, and apparently resulted in some marked right-sided weakness. She said Claimant’s cerebral vascular accident was unrelated to anyoccupational injury or event.

She cited a June 26, 2002, decision by the Texas Workers’ Compensation Commission’s Appeals Panel that Claimant was not pain-free and not fully functional subsequent to his prior cervical fusion procedure, with progressive neurologic loss documented in the record from his myelopathy.

She found no evidence to support prescription drugs as being reasonable and medically necessary to treat Claimant’s compensable injury in a situation where the overriding complicating and confounding medical conditions requiring ongoing evaluation and treatment pre-existed and pre-dated July 7, 1999, further complicated by carotid artery occlusive disease which resulted in the subsequent August 2000 cerebral vascular accident.

She said Claimant has been provided various classes of drugs including opiate-based pain medications, muscle relaxants, drugs for neuropathic pain, benzodiazepine-based sleep aides, anti-depressants and gastric blockers, with there being no indication from the claim chronology to support the use of any of these medications as an ongoing treatment for cervical strain or contusion from more than four years ago. (Carrier’s Exh. 2, 1-3).

b. Mark Renfro, M.D.

In anAugust 27, 1998, letter, written about 10 months before Claimant’s compensable injury occurred, Mark Renfro, M.D., states Claimant has a four-year history of low back pain, with occasional neck pain with little radiation into the arms or hands. He said Claimant’s lumbar MRI showed mild degenerative changes, but was otherwise is normal. His impression was that Claimant suffered from severe myelopathy. (Carrier’s Exh. 1, 3-4).

In an August 19, 1999, letter to Matthew Vierkant, M.D.,Dr. Renfro states Claimant had severe cervical stenosis for which he underwent an anterior cervical discectomy and fusion in September 1998. He said Claimant was myelopathic^[9] at the time. He said Claimant did well after the surgery until July 1999 when he was lifting a heavy box that fell on his back shoulder [sic]; subsequently Claimant noticed worsening of his leg tremors and shaking. He said Claimant also has more pain in his neck associated with occipital type headaches. (Carrier’s Exh. 1, 22).

c. Dr. Vierkant

In a July 19, 1999, visit with Dr. Vierkant, just 12 days after the compensable injury occurred, Claimant reported pain in his neck and low back. Dr. Vierkant’s note states, “He did have the cervical discectomy and fusion before, and this had helped a lot for a long period of time, but stated that this started again about two months ago and has been gradually worsening since that time.” The note goes on to say, “He states that he was working as a forklift operator but this was putting too much strain on his neck from having to look up, so they moved him into a different position.” (Carrier’s Exh. 1, 8).

Also on July 19, 1999, Dr. Vierkant described Claimant’s cervical spine films as showing the cervical fusion to be in place, with no evidence of fracture or other abnormalities. (Claimant’s Exh. 1, 9).

d. J. Stuart Crutchfield, M.D.

In a March 20, 2000, consultation with J. Stuart Crutchfield, M.D., a neurologist, Claimant complained of neck pain and bilateral upper extremity pain, as well as low back pain and right sciatica.^[10] Claimant told Dr. Crutchfield that this has been present for many years and did not relate any particular inciting event. Dr. Crutchfield concluded that Claimant’s cervical as well as lumbar complaints were most likely related to his cervical and lumbar spondylosis.^[11] (Carrier’s Exh. 1, 31-32).

On February 21, 2001, Dr. Crutchfield wrote that Claimant has a history of cervical surgery and cervical myelopathy, and now appears to be worsening. He said Claimant’s course has been complicated by a stroke. (Carrier’s Exh. 1, 54).

e. Dr. Fults

Dr. Fults, Claimant’s treating doctor, predicted after a June 5, 2000, visit with Claimant that Claimant will develop osteoarthritis in his neck and low back, and will have some degeneration over time. (Carrier’s Exh. 1, 44).

In a July 7, 2000, SOAP note, Dr. Fults noted that Dr. Crutchfield felt Claimant’s cervical fusion might be degenerating. Dr. Fults said Claimant “is in a deteriorating situation.”(Carrier’s Exh. 1, 45).

In a November 29, 2000, SOAP note, Dr. Fults referred to Claimant’s cervical MRI and said it suggested a myelomalacia, which is an abnormal softening of the spinal cord, in the C-5 area. (Carrier’s Exh. 1, 49).

In an April 17, 2001, SOAP note, Dr. Fults states again that Claimant’s condition is deteriorating. (Carrier’s Exh. 1, 65). In a May 2, 2001, SOAP note, Dr. Fults states Claimant’s condition will deteriorate gradually over time. (Carrier’s Exh. 1, 66).

f. Martin R. Steiner, M.D.

Martin R. Steiner, M.D., prepared a peer review on June 7, 2002, and found no evidence that Claimant’s compensable injury aggravated his pre-existing condition. He said Claimant’s July 31, 1999 MRI scan, performed approximately 24 days after the injury, demonstrated evidence of spinal cord atrophy with an area of myelomalacia.He said spinal cord atrophy takes months to occur, and myelomalacia does not appear for at least four-to-six months after an acute injury.Dr. Steiner concluded that the meylomalacia pre-existed the compensable injury, and within reasonable medical probability was secondary to his severe cervical spondylosis and spinal cord compression present in August 1998. He also concluded the MRI does not depict any new acute problem, disc herniations, or evidence of spinal cord compression, so there was no evidence that the July 7, 1999, incident caused any disruption of the cervical discs and cervical spinal cord. (Carrier’s Exh. 1, 114-119).

Dr. Steiner found the August 24, 1999 myelogram and post-myelogram CT scan to support his conclusion that the compensable injury was of no clinical significance in regards to causing abnormalities on Claimant’s imaging studies. (Carrier’s Exh. 1, 116).

He determined that the area of increased signal on the March 30, 2000 MRI most likely represented the myelomalacia seen on the July 31, 1999 MRI. (Carrier’s 1, 116).

He said the abnormalities present on Claimant’s March 19, 2001 cervical MRI were present in August 1998, as documented by Dr. Renfro.(Carrier’s Exh. 1, 114-119).

g. MRI reports

An August 23, 1999, radiology report by Kurt S. Reuland, M.D., from the first cervical myelogram and post-myelogram taken of Claimant’s cervical spine following his compensable injury, identifies post-op changes of anterior cervical fusion with plate, screws, and bone plug at C5 through C7, with the plate and screws in good position. Dr. Reuland reports the cervical alignment to be normal. His impression is mild central canal stenosis at the C5-6, C6-7 levels secondary to posterior and plate osteophytes.^[12] He found small uncovertebral spurs, right greater than left, at the C5-6 and C6-7 levels, and said there was no evidence of foraminal stenosis. He said mild disc bulges and small posterior cateophytes were present at C3-4 and C4-5, but there was no significant neural impingement. (Carrier’s Exh. 1, 23-24).

A March 19, 2001 MRI of Claimant’s cervical spine showed it to be stable with anterior cervical fusions at C5-6 and C6-7, and a small focus of myelomalacia in the right side of the cord at the level of the C5-6 disc that had not changed since the scan in March 2000. (Carrier’s Exh. 1, 58).

h. TWCC Appeals Panel decision

On August 14, 2002, a Texas Workers’ Compensation Appeals Panel affirmed the decision by a Commission hearing officer that Claimant’s compensable injury does not extend to include cervical myelopathy and/or cervical myelomalacia, and Claimant’s whole person impairment rating is six percent. (Carrier’s Exh. 1, 121-126).

Medical records supporting Claimant’s position

a. Dr. Renfro

After Claimant’s September 1998 two-level cervical fusion, he was seen by Dr. Renfro on December 1, 1998, who determined Claimant’s weakness was resolved, he was in no pain, and he was ambulating well. (Carrier’s Exh. 1, 6).

b. Dr. Fults

In a March 20, 2000 SOAP note, Dr. Fults’ assessment of Claimant was “He has been told he has cervical stenosis, most likely from the multiple surgeries and injury to his neck.” (Carrier’s Exh. 1, 30).

In an August 22, 2001 SOAP note, Dr. Fults stated that Claimant’s “insurance company is denying compensability of anything but the neck, however the neck is affecting the chondro myelomalacia and damage to the cord is affecting the entire body, both upper and lower extremities.” (Carrier’s Exh. 1, 78).

In a January 27, 2003 SOAP note Dr. Fults stated Claimant “is status post failed back surgery. He did have an exacerbation due to his compensable injury.” (Carrier’s Exh. 1, 129).

In a May 21, 2003 letter responding to peer review, Dr. Fults said Claimant is receiving opiate-level management due to his compensable injury, which severely aggravated his underlying cervical fusion. He said the fact that Claimant has ongoing myelopathy is not necessarily the issue; the issue is that although the fusion did to some degree correct his pre-existing condition, the compensable injury caused his central pain. He said Claimant was not suffering from chronic pain prior to his compensable injury, was not on medication at the time of his compensable injury, and was back at work performing his duties when the injury occurred. He concluded Claimant’s chronic pain is a direct result of his compensable injury. (Claimant’s Exh. 1, 12).

c. Dr. Crutchfield

Dr. Crutchfield, a neurosurgeon, examined Claimant on November 21, 2001. He reported Claimant to have “a significant upper and lower extremity impairment which I feel is secondary to his neck injury and not to a stroke. This is supported by the fact that he has bilateral symptomatology and does not have hemiparesis or hemisensory loss. He clearly has a cervical myelopathy and thus, I feel the neck injury caused this and not the stroke.” (Carrier’s Exh. 1, 98).

Medical records supporting a mixed view

a. John P. Obermiller, M.D.

John P. Obermiller, M.D., conducted a required medical examination (RME) of Claimant on September 6, 2001. His report states in part, “At this time I believe the ongoing complaints are mostly related to the stroke and not to the mechanism of injury on July 7, 1999.” Dr. Obermiller goes on to say, “We were asked what the relationship, if any; of the prior spinal surgery and degenerative disease process is to the current symptomatology. Once again, I believe there is a large relationship between the prior spinal surgery and the current symptomatology as well as the stroke.” He further states, “The alleged mechanism of injury appears to be the strain of his previous neck surgery. It appears his myelopathy and stroke have caused most of the problem.” Dr. Obermiller said Claimant’s medications are appropriate; as to whether they are all medically indicated with respect to his compensable injury, Dr. Obermiller concluded Claimant is “being treated for a myelopathy as well as a pain-type syndrome, partly of which is due to the alleged injury of 1999 and partly of which is due to the previous spinal surgery and partly of which is due to a stroke from August of 2000.” (Carrier’s Exh. 1, 86-90).

b. Wayne E. Hostetler, M.D.

Wayne E. Hostetler, M.D., a neurologist, examined Claimant and reported on April 1, 2002, that he could not comment as to whether Claimant’s mild cervical myelopathy was present prior to the 1999 compensable injury, except to say Claimant apparently got well enough to go back to work in 1998. He pointed out that examinations by neurologically knowledgeable people prior to the neck injury in 1999 would be extremely useful in determining how much of the current deficit was present prior to the 1999 injury. He also said one would have to wonder about the extent of which chronic pain and left hemisphere stroke might wear down a patient’s ability to overcome a deficit. (Carrier’s Exh. 1, 107-109).

Differing Opinions on Whole Body Impairment

a. R.W. Rodgers, M.D.: 70 percent whole body impairment rating

R.W. Rodgers, M.D., prepared a Discharge Summary Impairment Rating on July 24, 2001, finding that Claimant had reached statutory maximum medical improvement (MMI) on July 7, 2001, with a whole person impairment rating of 70 percent for cervical and lumbar pain syndrome; disc disruption; radiculopathy to the legs bilaterally; hyperreflexia of the lower extremities on the patellar tendons; and myelomalacia of the cervical spinal cord, which was found on an MRI. He said Claimant is also status post-cervical-fusion C5-6 and C6-7. He said that at the time of the examination, Claimant ambulated with difficulty, using a four-point cane, and was deteriorating. He observed that Claimant had some motor speech problems and some other situations associated with a stroke that might be difficult to sort out from the compensable injury. (Carrier’s Exh. 1, 71).

b. G. Peter Foox, M.D.: six percent whole body impairment ratingamended to 20 percent

On September 5, 2001, G. Peter Foox, M.D. found Claimant to have a whole body impairment rating of six percent, for the cervical area only. (Carrier’s Exh. 1, 82). He amended the rating to 20 percent on April 20, 2002, stating “In my opinion, the probability exists that this additional rating is unrelated to the Worker’s Compensation injury, but I will leave it up to the Commission and the carrier to decide on what proportion of contribution is in play here.” (Carrier’s Exh. 1, 110-111).

V. ANALYSIS AND CONCLUSION

A. Analysis

The ALJ finds Carrier met its burden of proving that the disputed medication was not medically necessary to treat Claimant’s compensable injury, because Claimant’s compensable injury of a sprain and contusion to the neck should have resolved within twelve weeks of the ___injury, rendering treatment from June 2003 through August 2003 medically unnecessary. The ALJ also finds Carrier met its burden of proving Claimant’s compensable injury did not aggravate a pre-existing cervical myelopathy, causing Claimant’s health to deteriorate to his current medical condition.

Claimant’s compensable injury was diagnosed as a cervical and lumbar sprain/strain, which the evidence shows should have resolved within eight-to-twelve weeks. Cervical spine films and an MRI taken just a few weeks after Claimant’s compensable injury occurred indicate his two-level cervical fusion was intact, his cervical alignment was proper, he had no significant nerve impingement, and there was no evidence of fracture or other abnormalities, leading the ALJ to find the ___ injury was not so serious as to exacerbate Claimant’s pre-existing condition.

There is sufficient evidence to show that Claimant’s compensable injury did not cause his current condition or aggravate his pre-existing myelopathy and myelomalacia.

• In a letter written some 10 months before Claimant’s compensable injury occurred, Dr. Renfro stated Claimant suffered from severe myelopathy and had a four-year history of back pain and occasional neck pain.
• In September 1998, Claimant underwent a two-level cervical fusion for severe cervical stenosis.
• Claimant told Dr. Vierkant on July 19, 1999, that the pain in his neck and low back had begun about two months prior, and had been worsening.
• Dr. Tonn concluded Claimant’s current condition is the result of pre-existing severe myelopathy and/or myelomalacia, which are not part of the compensable injury diagnosis.
• In March 2000 Dr. Crutchfield found Claimant’s neck pain, bilateral upper extremity pain, low back pain and right sciatica to have been present for many years, and related to Claimant’s cervical and lumbar spondylosis.
• On July 24, 2001, Dr. Rodgers said Claimant had some motor speech problems and some other situations associated with a stroke that might be difficult to sort out from the compensable injury.
• On September 6, 2001, Dr. Obermiller said myelopathy and stroke have caused most of Claimant’s medical problem. He said Claimant is being treated for myelopathy and a pain-type syndrome, which is partly due to his previous surgery, partly due to his stroke, and partly due to his compensable injury, which he characterized as a strain of a previous neck injury.
• In June 7, 2002, Dr. Steiner determined from Claimant’s July 31, 1999 MRI scan that there was no evidence of any acute injury secondary to Claimant’s compensable injury, or that the compensable injury caused any disruption of the cervical discs and cervical spinal cord. He said Claimant’s myelomalacia pre-existed the compensable injury, and within reasonable medical probability was secondary to Claimant’s severe cervical spondylosis and spinal cord compression present in August 1998.Dr. Steiner said the MRI scan performed on July 31, 1999, approximately 24 days after the compensable injury, demonstrated evidence of spinal cord atrophy with an area of myelomalacia. He said spinal cord atrophy takes months to occur and myelomalacia does not appear for at least four-to-six months after an acute injury. He concluded Claimant does not continue to suffer from the effects of his compensable injury.

Dr. Fults asserts that the reason Claimant is receiving opiate-level management is because his compensable injury severely aggravated his underlying cervical fusion, but the ALJ is not persuaded. Claimant’s cervical spine films taken July 19, 1999, showed his cervical fusion to be intact, and contained no evidence of acute injury. Claimant’s numerous MRIs, including the August 23, 1999 MRI done just a few weeks after his compensable injury, showed his cervical alignment to be normal, with no significant neural impingement.

The ALJ also is not persuaded by Dr. Crutchfield’s November 21, 2001 assertion that Claimant’s myelopathy was caused by his neck injury and not his stroke. Dr. Renfro’s August 1998 letter clearly indicates Claimant suffered from severe myelopathy some 10 months before his compensable injury occurred. The evidence shows Claimant had a pre-existing condition of severe myelopathy which the ALJ finds, along with his stroke, to be the cause of his current condition.

B. Conclusion

Carrier proved by a preponderance of the evidence that Claimant’s current medical condition did not naturally result from the sprain and contusion to his neck suffered on July 7, 1999. The disputed medication is not medically necessary to promote Claimant’s recovery from the sprain and contusion, which should have resolved by 12 weeks post-injury. Because the disputed medication is not medically necessary to treat Claimant’s compensable injury, he is not entitled to reimbursement from Carrier, pursuant to Tex. Lab. Code § 408.021(a). While the medication purchased by Claimant between June 18, 2003, and August 18, 2003, was medically necessary to treat his overall condition, it was not necessary to treat his compensable injury. Therefore, Carrier is not required to reimburse Claimant $179.60.

VI. FINDINGS OF FACT

1. Claimant sustained a compensable work-related injury to his neck on ___, while employed by a company whose workers’ compensation insurance carrier at the time was American Home Assurance Corporation (Carrier).
2. As a result of his compensable injury, Claimant suffered neck and low back pain.
3. Claimant was diagnosed to have cervical and lumbar sprain/strain as a result of his compensable injury.
4. In August 1998, some 11 months prior to the occurrence of Claimant’s compensable injury, he was diagnosed with severe myelopathy and a four-year history of back pain with occasional neck pain.
5. In September 1998, about 10 months prior to the occurrence of his compensable injury, Claimant underwent a two-level cervical fusion for severe cervical stenosis.
6. Claimant had been suffering low back and neck pain, which had been worsening, for about two months prior to the occurrence of the compensable injury.
7. Claimant’s ___ cervical films showed his cervical fusion to be in place, with no evidence of fracture or other abnormalities.
8. Claimant’s July 31, 1999 MRI demonstrated evidence of spinal cord atrophy with an area of myelomalacia. Spinal cord atrophy takes months to occur, and myelomalacia does not appear for at least four-to-six months after an acute injury. The MRI did not depict any new acute problem, disc herniations, or evidence of spinal cord compression.
9. The compensable injury did not cause any disruption of Claimant’s cervical discs or cervical spinal cord.
10. Claimant’s cervical and lumbar sprain/strain resulting from his compensable injury should have resolved themselves within eight-to-twelve weeks.
11. Claimant suffered a stroke in August 2000.
12. Claimant’s current neck pain, bilateral upper extremity pain, low back pain, and right sciatica have been present for many years, and are related to Claimant’s cervical and lumbar spondylosis.
13. Claimant’s current medical condition is the result of pre-existing severe myelopathy and/or myelomalacia, which are not part of the compensable injury diagnosis.
14. Claimant’s current medical condition requires him to use opiate-level pain management.
15. Claimant required medical therapy for pain control from June 18, 2003, through August 18, 2003, and his claim was no longer being paid by Carrier, so he purchased methadone for $34.45 on June 18, 2003, for $29.95 on July 21, 2003, and for $29.95 on August 18, 2003; Carisprodol for $21.25 on July 31, 2003; and hydrocodone for $63.00 on August 18, 2003, for total of $179.60.
16. Claimant sought reimbursement of $179.60 from Carrier for the medication he purchased.
17. Carrier refused to reimburse Claimant because, based on peer review, further treatment was not needed.
18. Claimant filed a request for medical dispute resolution with the Texas Workers’ Compensation Commission’s Medical Review Division (MRD), asking for reimbursement of $179.60 for the medication.
19. After reviewing the January 9, 2004, IRO decision which found the services to be medically necessary, the MRD issued a decision on January 14, 2004, ordering Carrier to pay the disputed medical fees.
20. On January 27, 2004, Carrier appealed the MRD decision to the State Office of Administrative Hearings (SOAH).
21. On February 25, 2004, the notice of the hearing in this case was mailed to Provider and Carrier.
22. The notice contained a statement of the time, place, and nature of the hearing; a statement of the legal authority and jurisdiction under which the hearing was to be held; a reference to the particular sections of the statutes and rules involved; and a short, plain statement of the matters asserted.
23. On June 10, 2004, SOAH Administrative Law Judge Sharon Cloninger held a hearing on Carrier’s appeal in the William P. Clements Building, Fourth Floor, 300 West 15^th Street, Austin, Texas. Carrier’s attorney Jim Korioth attended the hearing. Claimant appeared via telephone and was assisted by Juan Mireles, Ombudsman. The hearing concluded and the record closed that same day.

VII. CONCLUSIONS OF LAW

1. The State Office of Administrative Hearings has jurisdiction over matters related to the hearing in this case, including the authority to issue a decision and order, pursuant to Tex. Labor Code Ann. § 413.031(d) and Tex. Gov’t Code Ann. ch. 2003.
2. Carrier timely filed notice of appeal of the decision of the Texas Workers’ Compensation Commission’s Medical Review Division (MRD), as specified in 28 Tex. Admin. Code (TAC)§ 148.3.
3. Proper and timely notice of the hearing was provided in accordance with Tex. Gov’t Code Ann. § 2001.052 and 28 TAC § 148.4(b).
4. As the party appealing the MRD decision, Carrier has the burden of proving the case by a preponderance of the evidence, pursuant to 28 TAC § 148.21(h) and (i).
5. Based on the above Findings of Fact and Conclusions of Law, and pursuant to Tex. Labor Code § 408.021(a), the disputed medication was not reasonable and medically necessary to treat Claimant’s compensable injury, the effects naturally resulting from his compensable injury, or to promote his recovery from the compensable injury.
6. Based on the above Findings of Fact and Conclusions of Law, Carrier’s appeal should be granted, and Claimant should not be reimbursed $179.60.

ORDER

IT IS, THEREFORE, ORDERED THAT American Home Assurance Corporation is not required to reimburse Claimant $179.60 for medical prescriptions paid for by Claimant between June 18, 2003, and August 18. 2003.

Signed July 14, 2004.

SHARON CLONINGER
Administrative Law Judge
STATE OFFICE OF ADMINISTRATIVE HEARINGS

1. The Table of Disputed Services lists medication worth $179.60. (Claimant’s Exh. 1, 6.) The parties identified the amount in dispute as $979.04, based on the amount paid for Claimant’s prescriptions from June 18, 2003, through August 18, 2003, but the exhibit lists $179.60 worth of prescriptions as paid for in “cash,” and the remainder as paid for by “*tps,”with no explanation as to what “*tps” means. (Claimant’s Exh. 1, 9). The ALJ feels bound by the amount listed in the Table of Disputed Services.↑
2. The record contains varying accounts as to how Claimant injured his neck.↑
3. Myelomalacia is morbid softening of the spinal cord. Dorland’s Illustrated Medical Dictionary (1994), p. 1090.↑
4. Hyperreflexia is over-activity of physiological reflexes. Merriam Webster’s Medical Dictionary (1995), p. 307.↑
5. Patellar is of or pertaining to the patella (knee cap). Dorland’s Illustrated Medical Dictionary (1994), p. 1243.↑
6. Paresthesia is a sensation of pricking, tingling, or creeping on the skin having no objective cause and usually associated with injury or irritation of a sensory nerve or nerve root. Merriam Webster’s Medical Dictionary (1995), p. 501.↑
7. Antalgic is counteracting or avoiding pain, as a posture or gait assumed so as to lessen pain. Dorland’s Illustrated Medical Dictionary (1994), p. 90.↑
8. Myelopathy is a general term denoting functional disturbances and/or pathological changes in the spinal cord; the term is often used to designate non-specific lesions, in contrast to inflammatory lesions (myelitis). Dorland’s Illustrated Medical Dictionary (1994), p. 1090.↑
9. Myelopathy is any disease or disorder of the spinal cord or bone marrow. Id. at 442.↑
10. Sciatica is pain along the course of a sciatic nerve, especially in the back of the thigh caused by compression, inflammation, or reflex mechanisms. Id. at 620.↑
11. Spondylosis is any of various degenerative diseases of the spine. Id. at 653.↑
12. An osteophyte is a pathological bony outgrowth. Id. at 485.↑