{"id":"alj-G801538-2023-05-02","awcc_number":"G801538","decision_date":"2023-05-02","opinion_type":"alj","claimant_name":"Jarod Medart","employer_name":"University Of Arkansas Fayetteville","title":"MEDART VS. UNIVERSITY OF ARKANSAS FAYETTEVILLE AWCC# G801538 MAY 2, 2023","outcome":"granted","outcome_keywords":["granted:4"],"injury_keywords":["back","lumbar"],"pdf_url":"https://labor.arkansas.gov/wp-content/uploads/MEDART_JAROD_G801538_20230502.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"MEDART_JAROD_G801538_20230502.pdf","text_length":26345,"full_text":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \n WCC NO. G801538 \n \nJAROD MEDART, Employee CLAIMANT \n \nUNIVERSITY OF ARKANSAS FAYETTEVILLE, Employer RESPONDENT \n \nPUBLIC EMPLOYEE CLAIMS DIVISION, Carrier RESPONDENT \n \n \n \n OPINION FILED MAY 2, 2023 \n \nHearing   before   ADMINISTRATIVE   LAW   JUDGE   ERIC   PAUL   WELLS   in   Springdale, \nWashington County, Arkansas. \n \nClaimant represented by AARON L. MARTIN, Attorney at Law, Fayetteville, Arkansas. \n \nRespondents  represented  by  CHARLES H.  MCLEMORE,  Attorney  at  Law,  Little  Rock, \nArkansas. \n \n STATEMENT OF THE CASE \n \n On  February  7,  2023,  the  above  captioned  claim  came  on  for  a  hearing  at  Springdale, \nArkansas.      A  pre-hearing  conference  was  conducted  on  December  5,  2022,  and  a  Pre-hearing \nOrder  was  filed  on  December  6,  2022.      A  copy  of  the  Pre-hearing  Order  has  been  marked \nCommission's Exhibit No. 1 and made a part of the record without objection. \n At the pre-hearing conference the parties agreed to the following stipulations: \n 1.   The Arkansas Workers' Compensation Commission has jurisdiction of this claim. \n 2.   The relationship of employee-employer-carrier existed between the parties on April 4, \n2016. \n 3.   The claimant sustained a compensable injury to his low back on April 4, 2016. \n\nMedart – G801538 \n \n-2- \n 4.  The  claimant  was  earning  sufficient  wages  to  entitle  him  to  compensation  at  the \nweekly rates of $551.00 for temporary total disability benefits and $413.00 for permanent partial \ndisability benefits. \n 5. All prior opinions are final and res judicata. \n By agreement of the parties the issues to litigate are limited to the following: \n1.  Whether  Claimant  is  entitled  to  additional  medical  treatment  in  the  form  of  a  trial \nspinal cord stimulator as recommended by Dr. Jared Ennis for his compensable low back injury. \n Claimant’s contentions are: \n“The  Claimant  contends  that  the  recommended  trial  spinal  cord \nstimulator for his lower back is reasonable and necessary.” \n \n Respondents’ contentions are: \n \n“A  hearing  was  held  in  this  matter  on  February  19,  2019,  and  on \nApril 23, 2019. The issue to litigate at that time was the claimant’s \ndemands   for   additional   medical   treatment,   which   became   a \ndemand  for  a  surgery  performed  by  Dr.  Brandon  Evans  at  L5-S1 \non  February  21,  2019.  The  hearings  resulting  in an  opinion  of  the \nAdministrative   Law   Judge   dated   July   22,   2019,   which   was \naffirmed  and  adopted  by  the  Full  Commission  on  January  14, \n2020,    awarding    the    claimant    additional    medical    treatment \nincluding the surgery by Dr. Evans, and this opinion is now the law \nof  the  case  and  res  judicata.  The  Respondents  have  paid  the \nawarded  benefits,  including  providing  medical  treatment  for  the \nclaimant  reasonable  and  necessary  for  and  causally  related  to  the \ncompensable injury. \n \nThe  claimant  continued  to  complain  of  symptoms  after  his  fusion \nsurgery  and  has  been  provided  additional  medical  treatment  by \nRespondent.  The  claimant  was  provided  another  surgery  by  Dr. \nEvans on May 6, 2021, to remove hardware. The claimant has been \nprovided  ongoing  pain  management  and  injections.  Respondent \ndoes not pay for the claimant’s cannabis. \n \nThe  claimant  now  demands  that  he  be  provided  a  spinal  cord \nstimulator,  which  Respondent  has  not  authorized.  The  claimant \nwas seen by Dr. Carlos Roman who did not recommend the spinal \n\nMedart – G801538 \n \n-3- \ncord  stimulator  for  the claimant  but  did  recommend  medications \nwhich   Respondent   has   continued   to   provide   this   claimant. \nRespondent  contends  that  the  spinal  cord  stimulator  the  claimant \ndemands is not reasonable and necessary medical treatment for the \nclaimant’s injury. \n \nThe  Respondents  reserve  the  right  to  raise  additional  contentions, \nor  to  modify  those  stated  herein,   pending  the  completion  of \ndiscovery.” \n \n \n The claimant in this matter is a 36-year-old male who sustained a compensable injury to \nhis low back on April 4, 2016. The claimant has asked the Commission to consider whether he is \nentitled  to  additional  medical  treatment  in  the  form  of  a  trial  spinal  cord  stimulator  as \nrecommended  by  Dr.  Jared  Ennis  for  his  compensable  low  back  injury.  The  claimant  has \nundergone  two  lower  back  surgeries  due  to  his  compensable  low  back  injury.  The  first  surgery \nwas  done  in  February  of  2019,  which  primarily  involved  a  fusion  of  L5-S1.  It  should  be  noted \nthat Dr. D. Luke Knox was, and still is, the claimant’s treating neurosurgeon; however, Dr. Knox \nstopped  performing  surgery  prior  to  the  claimant’s  February  2019  surgery.  Dr.  Brandon  Evans \nactually performed the claimant’s surgical intervention. The claimant continued to treat with Dr. \nKnox  after  his  surgical  intervention.  That  surgical  intervention  is  well  documented  in  the \nprevious hearing transcripts which has been made part of the record in this matter. \n The  claimant  was  asked  about  his  February  of  2019  surgery  and  its  outcome  on  direct \nexamination as follows: \nQ Okay. Mr. Medart, we are here today to address  additional \nmedical treatment in your case, specifically a trial for a spinal cord \nstimulator.  We  submitted  a  lot  of  medical  records  so  I  want  to  go \nback, and  I don’t want to detail everything, but  you had a surgery \nin February of 2019. Do you recall that procedure? \n \nA I do. \n \n\nMedart – G801538 \n \n-4- \nQ Did you get any benefit from that procedure? \n \nA I did. \n \nQ  Tell me about that. \n \nA We had the surgery to fuse my L5-S1 and the benefit that I \ngot  from  that,  my  back  would  no  longer  go  out  so  that  I couldn’t \nwalk   for   several   days.   But   then   approximately   three   months \nafterwards,  the  majority  of  the  benefit  had  worn  off  and  I  started \nhaving symptoms going down the back of my legs. \n \n Following  the  claimant’s  first  surgical  intervention,  the  claimant  began  physical  therapy \nat   Total   Spine.   The   claimant   continued   with   complaints   of   low   back   pain   and   lumbar \nradiculopathy.  The  claimant  began  treatment  at  Interventional  Pain  Specialists  with  both  Dr. \nJarod  Ennis  and  Dr.  Jason  Holt.  This  treatment  included  lumbar  spine  injections  to  treat  the \nclaimant’s  continued  low  back  symptoms.  In  December  of  2019  the  claimant  again  attended \nphysical  therapy  for  his  low  back  symptoms.  The  claimant’s  difficulties  continued  into  early \n2020 even  after  physical  therapy  and  receiving  additional  epidural  steroid injections  located  in \ndifferent areas of his lower lumbar spine. \n An  MRI  of  the  claimant’s  lower  back  was  ordered  by  Dr.  Knox.  After  that  MRI  was \nperformed,  the  claimant  was  seen  by  Dr.  Knox  on  August  20,  2020.  Following  is  a  portion  of \nthat medical record: \nAugust 20, 2020 reviewed patient’s MRI scan. Appears to show a \nnice  decompression  at  the  fusion  site.  Would  not  recommend  any \nother  surgical  endeavors  at  this  time  will  plan  to  follow  up  in  6 \nmonths.  We  discussed  possibility  of  hardware  removal  at  2  years \npostop which would take him to February 2021 will plan follow-up \nin 6 months. Will send prescription for orthopedic bed issues/refer \nto  note  May  19,  2020  patient  now  15  months  status  post  lumbar \nfusion  now  with  complaints  of  cauda  equina  syndrome  would \nrecommend that he get MRI scan return to clinic reviewed his MRI \nscan    back    and    September    demonstrating    no    evidence    of \ncompressive  pathology  will  plan  to  follow  up  after  the  MRI  scan \n\nMedart – G801538 \n \n-5- \nDecember   2,   2019.   Patient   improving   with   shoe   inserts   and \nmedications. He failed epidurals. Informed him that the next step is \nto  consider  for  RF  lesion  will  plan  to  follow  up  in  6  months  and \nredo x-rays at that time. \n \n The  claimant  then  continued  treating  with  Dr.  Ennis  and  Dr.  Holt.  On  September  11, \n2020, Dr. Holt first indicated that the claimant “may consider SCS trial in the future.” This is the \nfirst  time  in  the  medical  record  that  a  spinal  cord  stimulator  trial  appears  to  be  considered.  On \nMay 6, 2021, the claimant goes forward with hardware removal again at the hands of Dr. Evans, \nbut  the  claimant  remains  under  the  care  and  treatment  of  Dr.  Knox  who  no  longer  performs \nsurgery. The claimant was asked on direct examination about the effects of his second surgery in \nthe form of hardware removal as follows: \nQ Okay.  And  the  records  show  you  had  a  surgery  again  on \nMay  6\nth\n  of ’21  to  remove  that  hardware.  Did  you  get  any  benefit \nfrom that procedure? \n \nA Short-lived.  It  was  about  three  months  again  that  I  got \nbenefit from that before the pain started coming back. \n \n On July 22, 2021, the claimant was again seen by Dr. Ennis regarding his continued low \nback   difficulties.   Following   is   a   portion   of   that   medical   record   in   which   it   discusses \nrecommended steps prior to considering a spinal cord stimulator trial: \nDiagnosis: \n*** \nPleasant  gentleman  presents  for  evaluation  and  treatment  of  his \nworsening   lower   back   pain.   H/o   pain   since   2016   which   has \ncontinued  to  worsen.  Severe  exacerbation  of  pain  d/t  a  lifting \ninjury  while  at  work  in  April  2016.  He  has  completed  x2  series \nw/Yumang  Rehab  and  injections.  Ultimately  underwent  L5  S1 \nfusion w/Dr. Evans in February 2019. Successful surgery and pain \nfree for several months; but reports residual/worsening symptoms. \nMRI   L/S   (July   2020)   showing   dorsal   fusion   of   S1   and   L5 \nvertebrae. L5/S1 level mild degenerative endplate change. Minimal \nbilateral neural foraminal stenosis. \n \n\nMedart – G801538 \n \n-6- \nPt  presents  today  for  follow  up.  Underwent  hardware  removal \nw/Dr.  Evans  on  05/06/21.  Experienced  1  week  of  relief  following \nsurgery,  unfortunately  since  then  radiating  pain  has  returned.  On \nexam,  describing  a  B/L  S1  pain  pattern.  He  did  visit  w/Dr.  Knox \nand discussed SCS; per patient Dr. Knox recommended re-trialing \ninjection  prior  to  consider  SCS.  I  agree.  Added  Lyrica  50mg  BID \nwhich   has   offered   some   improvement.   Otherwise   continues \nw/HCD and baclofen to  QID to offer 20mg dosing once daily. As \nwell  as  Lyrica  75mg  BID.  Otherwise,  will  obtain  approval  for \nbilateral S1 LTF. \n \nThe claimant continued with injections as recommended by Dr. Ennis and Dr. Knox.  \n On October 21, 2021, the claimant was seen by Dr. Ennis. Following is a portion of that \nmedical report: \nHistory of Present Illness: \nPainful area(s): back, buttock, thighs \nProgress in treatment: return to baseline \nPain  description:  low   back  w/<  radiation  to  b/l  gluteals  and \nposterior thighs \nRecent intervention: bilateral S1 LTF \nResults of treatment: inadequate relief \nAmount of relief: no relief \nAverage activity level since last visit: unchanged \n \nJarod  returns  today  for  further  evaluation.  No  benefit  from  repeat \nbilateral   S1   LTF.   His   symptoms   have   returned   to   baseline. \nContinues  to  struggle  w/lower  back,  b/l  glute  and  posterior  thigh \npain.  He  did  visit  w/Dr.  Knox  who  also  agreed  w/completion  of \nseries and consider SCS if lackluster. No medication changes. \n \n*** \nDiagnosis: \nM96.1 – POSTLAMINECTOMY SYNDROME, NOT \nELSEWHERE CLASSIFIED \nM51.16 –     INTERVERTEBRAL     DISC     DISORDERS     W \nRADICULOPATHY, LUMBA \nM48.062 –   SPINAL   STENOSIS,   LUMBAR   REGION   WITH \nNEUROGENIC CLAUD \n \nPleasant  gentleman  presents  for  evaluation  and  treatment  of  his \nworsening   lower   back   pain.   H/o   pain   since   2016   which   has \ncontinued  to  worsen.  Severe  exacerbation  of  pain  d/t  a  lifting \n\nMedart – G801538 \n \n-7- \ninjury  while  at  work  in  April  2016.  He  has  completed  x2  series \nw/Yumang  Rehab  and  injections.  Ultimately  underwent  L5  S1 \nfusion w/Dr. Evans in February 2019. Successful surgery and pain \nfree  for  several  months;  but  report  residual/worsening  symptoms. \nMRI   L/S   (July   2020)   showing   dorsal   fusion   of   S1   and   L5 \nvertebrae. L5/S1 level mild degenerative endplate change. Minimal \nbilateral  neural  foraminal  stenosis.  Underwent  hardware  removal \nw/Dr.  Evans  on  05/06/21.  Experienced  1  week  of  relief  following \nsurgery, unfortunately since then radiating pain has returned. \n \nReturns today for cont’d evaluation. Unfortunately no benefit from \nrepeat  b/l  S1  LTF.  Pain  has  returned  to  baseline.  Continues  to \nstruggle  w/back  and  b/l  glute  and  posterior  leg  pain  to  the  knees. \nDescribing  a  S1  pattern.  He  did  visit  w/Dr.  Knox;  per  patient \nagreed to finish out series was appropriate. As well as SCS if series \nlackluster.  Would  like  to  obtain  new  MRI  prior  to  this  step.  He \nremains  on  HCD,  baclofen,  and  Lyrica.  Completing  HEP/walking \nat local park for exercise. Discussed his cont’d pain/symptoms, and \nwould  like  to  change  approach  to  caudal.  Will  plan  to  evaluate \nfollowing.   If   no   benefit,   will   proceed   w/new   MRI   and   if \nappropriate and Dr. Knox agrees; will move to SCS trial. \n \nThe   claimant   underwent   the   recommended   caudal   approach   to injections;   however,   his \nsymptoms continued. Following is a portion of a medical record dated December 8, 2021, from \nInterventional Pain Specialists: \nJarod    returns    today    to    evaluate    progress    following    series \ncompletion.  Change  to  caudal   approach  proved  one   week  of \nbenefit.  He  continues  to  struggle  greatly  w/lower  back,  bilateral \nbuttock and posterior leg pain. Medications remain the same. He is \nscheduled to see Dr. Knox next week. \n \n On December 14, 2021, the claimant is again seen by Dr. Knox. Following is a portion of \nthat medical record: \nHPI:  Mr.  Jarod  Medart  was  seen  in  the  Northwest  Arkansas \nNeurosurgery  Clinic,  along  with  his  wife,  on  12/14/21  for  follow-\nup. As you know, he continues to be plagued with significant back \nand  bilateral  leg  pain.  It  originally  started  out  as  right  leg  pain. \nInterestingly, he says that when he got his Covid booster, it really \nflared up his sciatica. \n \n\nMedart – G801538 \n \n-8- \nPLAN:  From  my  standpoint,  he  wants  to  consider  spinal  cord \nstimulator. I believe he is probably an excellent candidate for this. \nTo  that  end,  we  need  to  redo  his  lumbar  MRI  scan  with/without \ncontrast after which we will reevaluate and consider the possibility \nof a spinal cord stimulator. \n \n On February 7, 2022, the claimant is  again seen  by Dr. Knox. Following  is a portion of \nthe Plan section of that medical record: \nFebruary  7,  2022.  Patient  seen  virtual  office  visit.  Reviewed  his \nMRI  scan.  The  fusion  appears  solid.  He  continues  to  be  plagued \nwith  back  and  bilateral  sciatica.  His  primary  complaint  is  the \nbilateral  sciatica.  In  view  of  that  I  would  recommend  that  he \nconsider  spinal  cord  stimulator.  He  is  to  follow-up  with  pain \nmanagement  consideration  of  dorsal  column  stimulator.  Will  plan \nto    follow-up    p.r.n.    We    discussed    possibility    of    medical \nmarijuana/cannabis  card.  He  is  contact  us  of  he  wants  to  pursue \nthis avenue. \n \n On  May  10,  2022,  the  claimant  was  seen  for  a  second  opinion  at  the  request  of  the \nrespondents  by  Dr.  Carlos  Ramon  at  Proper  Pain  Solutions.  Following  is  a  portion  of  Dr. \nRamon’s report: \nHISTORY OF PRESENT ILLNESS: \nThe   patient   is   a   35-year-old   gentleman   who   worked   for   the \nUniversity of Arkansas in the IT Department. In April of 2016, he \nwas lifting a projector and felt severe pain in his back. He was seen \ninitially  by  Dr.  Hudu.  They  did  some  x-rays  of  the  lumbar  spine \nand looked normal. He had some transitional anatomy at the L5-S1 \nlevel.  He  had  physical  therapy.  They  did  and  MRI  of  his  lumbar \nspine, initially in June 2016, which showed a small annular tear at \nthe L4-L5 level, mild facet disease, mild-to-minimal stenosis at the \nL5-S1  level.  He  saw  Dr.  Nalley,  at  Ozark  Orthopedics,  who  put \nhim  back  at  light  duty,  did  not  think  surgery  would  be  of  benefit. \nThe  patient  returned  to  work,  continued  to  struggle  with  his  back \npain.  He  subsequently  went  back  in  2018,  saw  Dr.  Knox,  got  an \nupdated  MRI.  There  was  a  moderate  central  disc  bulge  at  the  L5-\nS1,   again   with   only   mild   stenosis.   They   referred   to   pain \nmanagement. He had epidural injections, bilateral transforaminal at \nL5-s1,  without  relief.  A  third  MRI  was  done  in  January  2019 \nshowing  mild  bilateral  foraminal  stenosis  and  a  disc  bulge  at  the \nL5-S1. No changes on x-ray. He then had a lumbar fusion surgery \n\nMedart – G801538 \n \n-9- \nin  February  2019  by  Dr.  Evans.  He  indicated  it  was  for  low  back \npain  secondary  to  dicogenic  pain.  They  did  an  interbody  fusion. \nDr.  Knox  followed  him  up  after  surgery.  The  patient  continued  to \ncomplain of low back pain, pain down his right leg worse than the \nleft. They did a follow-up MRI and the lumbar fusion at L5-S1 was \nnormal.  He  continued  to  complain  of  pain.  He  had  discussed \npossible  spinal  cord  stimulator  and  ultimately  did  another  CT  in \nMarch of 2021, and they removed the hardware. He had hardware \nremoval  of  the  fusion  at  the  L5-S1.  Since  the  removal,  he  is  still \nhaving  ongoing  pain  symptoms,  particularly  complaining  of  pain \ndown the legs and low back. The patient has said that the surgeries \noverall  helped  his  severe  pain,  but  he  still  deals  with  chronic \nongoing  refractor  pain.  He  has  been  on  a  host  of  long-term \nmedications,  but  he  does  have  hydrocodone  moderately,  7.5  mg \ntables  as-needed,  dispense  #60  per  month.  He  was  on  gabapentin, \nwhich  did  not  show  good  relief  as  far  as  his  leg  pain,  but  also \ncaused a lot of sedation; so they put him on Lyrica 75 mg tablets, \ndispense  #60,  which  he  tolerates  fairly  well.  He  is  on  baclofen  10 \nmg  tablets  four  times  a  day.  Those  are  his  medications  as  far  as \npain  management  is  concerned.  They  have  also  proposed  a  spinal \ncord stimulator. We had an extensive consultation about treatment \noptions, and pros and cons of spinal cord stimulation. His last MRI \nof   the   lumbar   spine,   the   canal   is   open,   there   is   no   severe \ngranulation  tissue  encapsulating  a  nerve  root,  he  has  no  stenosis \nabove  or  below.  He  is  complaining  of  pain  down  both  legs,  but \nthere  is  no  objective  rationale  for  him  to  have  ongoing  radicular \npain down his legs.  I cannot recommend spinal  cord stimulator.  It \nwill  not  change  his  outcome.  There  is  not  an  objective  rationale \nthat is causing his ongoing leg pain. He says the leg pain is worse \nthan  the  back  pain.  He  gets  occasional  short  term  relief  from \nepidural injections.  I think the risk-to-benefit on a stimulator does \nnot favor the patient and, again, I do not see an objective rationale \nfor placement. The reason for spinal cord stimulator for failed back \nwould be ongoing stenosis not amenable to surgery or granulation \ntissue  developed  on  nerve  root  causing  chronic  severe  unilateral \nnerve  pain  or  impingement.  Global  pain  in  the  back,  and  down \nboth  hips  and  legs  is  not  going  to  be  an  indication.  He  has  had \nprevious surgeries without enough relief. \n \nThough the patient says he has got relief, he still does not know if \nhe can  continue working given the amount of ongoing pain. He is \nof young age at 35 years of age. We had a very extensive consult. I \ndo  not  recommend  spinal  cord  stimulator  for  the  patient.  I  think \nthere should be adjustment of medications. I think his opiate use is \n\nMedart – G801538 \n \n-10- \nappropriate.  Occasional  injections  have  been  of  benefit.  He  does \nnot need further surgeries, either. \n \n*** \nCURRENT MEDICATIONS: \nHe   is   on   omeprazole,   baclofen,   sertraline,   Norco,   lostatan, \nhydrochlorothiazide, metoprolol, Lyrica, and aspirin. \n \nPHYSICAL EXAM: \nAn    alert    and    oriented,    well-developed    and    well-nourished \ngentleman.  Height  5  feet  11  inches,  weight  265  pounds.  O2  sat  is \n97%,  heart  rate  is  80,  and  respiratory  rate  is  10.  Cranial  nerves  II \nthrough  XII  are  grossly  intact.  Ambulates,  he  does  have  a  cane \nwith  him  and  says  uses  it  on  occasion.  Lumbar  spine  has  a  well-\nhealed,  three-inch  incision.  He  is  not  over  point  tender  over  the \nguteal  bursa.  He  complains  of  pain  in  his  buttocks  and  down  the \nback of his legs. Muscle tone is appropriate and symmetric for his \nage  and  condition.  No  global  weakness.  Peripheral  pulses  are \npalpable.  No  gross  muscle  atrophy  of  asymmetry  in  the  lower \nextremities.  Range  of  motion  of  the  hips,  knees,  and  ankles  is \nappropriate. No weakness or footdrop of any kind. \n \nFINAL ASSESSMENT: \n1. Chronic, ongoing low back pain. \n2. Lumbar fusion, L5-S1 level. \n3. Current long-term use of medications. \n \n*** \nFINAL DIAGNOSIS: \n1. Low back pain. \n2. Lumbar fusion, L5-S1. \n3. Long-term opiate use. \n \n On September 20, 2022, Dr. Ennis authored a letter regarding the claimant and Dr. Ennis’ \nbelief in the claimant’s need to undergo a spinal cord stimulator trial as follows: \nOur clinic has treated Mr. Medart since 2018. He has not received \nmeaningful  benefit  from  injections,  medications,  physical  therapy \nand  surgery  including  fusion  in  2019  and  hardware  removal  in \n2021.  He  has  continued  to  be  plagued  with  bilateral  posterior  leg \npain.  MRI  obtained  in  March  2022.  Evaluated  by  Dr.  Knox  who \nalso  agreed  and  recommended  moving  forward  with  spinal  cord \nstimulator trial. He is 36 years old and would prefer to avoid high \ndoses  of  medications,  since  he  is  likely  to  continue  with  opiate \n\nMedart – G801538 \n \n-11- \nmedications  chronically.  Unfortunately,  his  alternatives  would  be \nfurther   surgical   treatment   or   long-term   use   of   interventional \nsteroids. \n \n The  only  issue  before  the  Commission  is  the  claimant’s  request  for  additional  medical \ntreatment in the form of a spinal cord stimulator trial. As such, it must be determined if a spinal \ncord  stimulator  trial  is  reasonable,  necessary  medical  treatment  for  the  claimant’s  compensable \nApril  4,  2016,  low  back  injury.  The  claimant  has  undergone  two  surgeries  which  include  one \nfusion  at  L5-S1  and  the  later  hardware  removal  surgery.  The  claimant  has  prior  to,  and  post-\nsurgery,  undergone  extensive  conservative  treatment,  including  physical  therapy,  medication, \nand injections. The claimant still struggles with low back pain and lumbar radiculopathy from his \ncompensable low back injury, even after both surgical and conservative care.  \n Dr.  Ramon’s  second  opinion  is  clear  that  he  believes  the  claimant  should  continue \ntreatment but not through a spinal cord stimulator trial. However, I believe that Dr. Ennis and Dr. \nKnox are in the best position to determine the treatment path for the claimant as they have both \nlong  participated  in  his  care,  having  had  the  opportunity  to  see  the  claimant  on  occasions  both \nprior to and after surgical intervention and participate in the conservative treatment that has been \ngiven  throughout  the  claimant’s  time  since  his  compensable  injury.  I  find  that  the  spinal  cord \nstimulator  trial  recommended  by  both  Dr.  Knox  and  Dr.  Ennis  to  be  reasonable,  necessary \nmedical treatment for the claimant’s April 4, 2016, compensable low back injury. \n From a review of the record as a whole, to include medical reports, documents, and other \nmatters properly before the Commission, and having had an opportunity to hear the testimony of \nthe  witness  and  to  observe  his  demeanor,  the  following  findings  of  fact  and  conclusions  of  law \nare made in accordance with A.C.A. §11-9-704: \n \n\nMedart – G801538 \n \n-12- \n FINDINGS OF FACT & CONCLUSIONS OF LAW \n 1.  The  stipulations  agreed  to  by  the  parties  at  the  pre-hearing  conference  conducted  on \nDecember  5,  2022,  and  contained  in  a  Pre-hearing  Order  filed December  6,  2022,  are  hereby \naccepted as fact. \n 2.  The  claimant  has  proven  by  a  preponderance  of  the  evidence  that  he  is  entitled  to \nadditional  medical  treatment  in  the  form  of  a  trial  spinal  cord stimulator  as  recommended  by \nboth   Dr.   Knox   and   Dr.   Ennis   as   it   is   reasonable,   necessary   medical   treatment   for   his \ncompensable low back injury. \n ORDER \n The  respondents  shall  be  responsible  for  the  costs  associated  with  the  claimant’s \nreasonable, necessary spinal cord stimulator trial. \nPursuant  to  A.C.A.  §11-9-715(a)(1)(B)(ii),  attorney  fees  are  awarded  “only  on  the \namount of compensation for indemnity benefits controverted and awarded.”   Here, no indemnity \nbenefits were controverted and awarded; therefore, no attorney fee has been awarded.   Instead, \nclaimant’s attorney is free to voluntarily contract with the medical providers pursuant to A.C.A. \n§11-9-715(a)(4). \nIf  they  have  not  already  done  so,  the  respondents  are  directed  to  pay  the  court  reporter, \nVeronica Lane, fees and expenses within thirty (30) days of receipt of the invoice. \n \n IT IS SO ORDERED. \n \n \n                                ____________________________                                              \n       HONORABLE ERIC PAUL WELLS \n       ADMINISTRATIVE LAW JUDGE","preview":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. G801538 JAROD MEDART, Employee CLAIMANT UNIVERSITY OF ARKANSAS FAYETTEVILLE, Employer RESPONDENT PUBLIC EMPLOYEE CLAIMS DIVISION, Carrier RESPONDENT OPINION FILED MAY 2, 2023 Hearing before ADMINISTRATIVE LAW JUDGE ERIC PAUL WELLS in Springdale, Washington Co...","fetched_at":"2026-05-19T23:07:07.451Z","links":{"html":"/opinions/alj-G801538-2023-05-02","pdf":"https://labor.arkansas.gov/wp-content/uploads/MEDART_JAROD_G801538_20230502.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}