{"id":"alj-G807060-2024-02-27","awcc_number":"G807060","decision_date":"2024-02-27","opinion_type":"alj","claimant_name":"Tina Melius","employer_name":"Chapel Ridge Nursing Ctr","title":"MELIUS VS. CHAPEL RIDGE NURSING CTR. AWCC# G807060 FEBRUARY 27, 2024","outcome":"denied","outcome_keywords":["denied:6"],"injury_keywords":["back","strain","hip","lumbar","herniated","knee"],"pdf_url":"https://labor.arkansas.gov/wp-content/uploads/MELIUS_TINA_G807060_20240227.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"MELIUS_TINA_G807060_20240227.pdf","text_length":35629,"full_text":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION \n \n WCC NO. G807060 \n \nTINA MELIUS, Employee CLAIMANT \n \nCHAPEL RIDGE NURSING CTR., Employer RESPONDENT \n \nAMTRUST NORTH AMERICA, Carrier RESPONDENT \n \n \n \n OPINION FILED FEBRUARY 27, 2024 \n \nHearing  before  ADMINISTRATIVE  LAW  JUDGE  ERIC  PAUL  WELLS  in  Fort  Smith, \nSebastian County, Arkansas. \n \nClaimant represented by MATTHEW J. KETCHAM, Attorney at Law, Fort Smith, Arkansas. \n \nRespondents   represented   by   WILLIAM   C.   FRYE,   Attorney   at   Law,   North   Little   Rock, \nArkansas. \n \n STATEMENT OF THE CASE \n \n On November 30, 2023, the above captioned claim came on for a hearing at Fort Smith, \nArkansas.   A pre-hearing conference was conducted on September 25, 2023, and a Pre-hearing \nOrder  was  filed  on  October  31,  2023.      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 July 11, \n2018. \n 3. The claimant sustained a compensable piriformis injury to her buttock and right thigh \non July 11, 2018. \n 4. The compensation rates are the maximum. \n\nMelius – G807060 \n \n-2- \n 5. All prior opinions are res judicata and the law of this case. \n By agreement of the parties the issues to litigate are limited to the following: \n 1.  Whether  Claimant  is  entitled  to  additional  medical  treatment  for  her  compensable \npiriformis  and  right  thigh  injuries  that  occurred  on  July  11,  2018,  or  alternatively,  whether \nClaimant sustained a compensable injury to her low back on or about July 11, 2018. \n 2. Whether Claimant is entitled to medical treatment for compensable low back injury. \n 3.  Whether  Claimant  is  entitled  to  temporary  partial  disability  benefits  from  September \n19, 2019, to a date yet to be determined. \n 4. Respondents raise the Statute of Limitations defense. \n 5. Whether Claimant’s attorney is entitled to an attorney fee. \nThe claimant's contentions are as follows: \n“1. The above-listed proposed stipulations. \n \n2. The Claimant was injured on July 11, 2018 while assisting EMS \npersonnel who were moving a patient from a bed to a gurney. The \nClaimant  was  grabbed  by  the  patient  while  lowering  the  patient \nonto  the  gurney  which  caused  the  claimant  to  come  up  onto  her \nright  tiptoes.  The  Claimant  felt  a  pop  in  her  glute  and  a  muscle \nspasm in her thigh and calf. \n \nOn  July  11,  2018,  the  Claimant  was  instructed  to  see  Dr.  Keith \nHolder at Mercy Clinic Occupational Medicine with complaints of \nsharp  pain  in  right  glute.  Dr.  Holder  diagnosed  the  claimant  with \nstrain  of  muscle,  fascia  and  tendon  of  right  hip.  Dr.  Holder  also \nrestricted  the  Claimant  to  light  duty  with  a  follow-up  in  seven  (7) \nto  ten  (10)  days  as  well  as  hip  exercises  and  a  cane  to  ambulate \nwith. \n \nOn  July  19,  2018,  the  Claimant  returned  to  Dr.  Holder  for  a \nfollow-up where she stated that the pain is worse at night as well as \nwith  sitting.  Dr.  Holder  kept  the  Claimant  restricted  to  light  duty \nand referred her for therapy. \n \n\nMelius – G807060 \n \n-3- \nThe   Claimant   continued   to   follow-up   with   Dr.   Holder   who \ncontinued   to   refer   the   Claimant   for   therapy   as   well   as   her \nrestriction to light duty. \n \nOn  August  13,  2018,  the  Claimant  attended  physical  therapy  for \nstrain  of  muscle,  fascia  and  tendon  of  right  hip  where  it  is  noted \nshe has decreased range of motion and strength as well as gait and \npostural deficits. The Claimant was approved for six (6) visits. \n \nOn  August  23,  2018,  the  Claimant  was  seen  by  Dr.  Holder  where \nhe recommended the Claimant to finish therapy and that he would \nrequest  an  MRI  of  the  Claimant’s  lumbar  spine  and  right  thigh \nwhich was denied. \n \nOn  October  2,  2018,  the  Claimant  once  again  seen  by  Dr.  Holder \nwhere  he  referred  the  Claimant  for  steroid  injection  by  pain \nmanagement. Dr. Holder kept the Claimant on light duty. \n \nOn  November  13,  2018,  the  Claimant  was  seen  by  Dr.  Brian \nGoodman  for  pain  management  where  it  he  recommended  the \nClaimant getting trigger point injection in the right  gluteal muscle \nas well as stretching exercises and to follow-up in one (1) month. \n \nThe  Claimant  returned  once  more  to  Dr.  Holder  for  a  follow-up. \nHowever,  any  further  treatment  was  denied  by  the  Respondents. \nWhile the Claimant was going through the workers’ compensation \nprocess,  she  continued  to  seek  treatment  using  her  own  private \nhealth insurance. \n \nOn July 18, 2019, the Claimant present to Dr. Thomas Cheyne for \ncontinued right hip pain. Dr. Cheyne’s diagnosed was chronic right \nhip  pain,  probable  hamstring  tendon  injury.  He  recommended  an \nMRI  of  right  hip  and  pelvis  as  well  as  referred  the  Claimant  for \nphysical therapy. \n \nThe Claimant had an MRI completed which was normal. However, \nDr.  Cheyne  referred  the  Claimant  for  a  second  opinion  to  try  to \nlocate  the  source  of  the  pain.  In  the  meantime,  the  Claimant \ncontinued to attend physical therapy for a right hamstring injury. \n \nOn August 21, 2019, the Claimant was seen by Dr. Greg Jones for \na  second  opinion.  Dr.  Jones  notes  the  Claimant’s  radicular  pain \nsymptoms down the right leg. Dr. Jones states that he believes that \nthe  Claimant  has  suffered  a  low  back  injury  and  has  requested  a \nlumbar MRI. \n\nMelius – G807060 \n \n-4- \n \nThe Claimant returns to Dr. Jones post-MRI on September 4, 2019 \nand  it  was  found  that  the  Claimant  has  lumbar  stenosis,  facet \nhypertrophy and degenerative disc changes at L4-5 and L5-S1 disc \nprotrusion.  Dr.  Jones  changes  the  Claimant’s  physical  therapy  to \nfocus on the Claimant’s lumbar spine but that she is to continue on \nlight duty work restrictions. \n \nThe Claimant continued with physical therapy treatment. \n \nOn  November  23,  2021,  the  Claimant  returned  to  Dr.  Cheyne  for \ncontinued  pain  where  Dr.  Cheyne  opined  his  opinion  that  they \nright  glute  pain  comes  from  the  Claimant’s  low  back  and  referred \nthe Claimant for additional trigger point injections. \n \n3.  Claimant  reserves  the  right  to  supplement  and  amend  her \ncontentions after additional discover has been completed.” \n \n The respondents’ contentions are as follows: \n“Respondents  contend  that  the  Claimant  did  have  a  piriformis \ninjury that the Court of Appeals said was in the right buttocks but \nnot the low back. The Claimant apparently is now having problems \nin the low back. The Claimant testified at the previous hearing that \nher  low  back  was  not  injured  in  July  11,  2018.  The  Court  of \nappeals  found  the  Claimant  sustained  a  piriformis  injury  and  a \nclaim for the low back was not filed until the statute of limitations \nhad  run  on  this  case.  The  Claimant  is  also  contending  that  she  is \nentitled  to  temporary  total  disability  benefits.  The  Commission \nfound   that   the   Claimant   was   entitled   to   Temporary   Partial \nDisability   until   sometime   between   September   of   2018   and \nDecember  of  2018  when  she  began  a  new  position  with  the \nRespondents. The Claimant has not provided any off work slips. In \naddition,   she   voluntarily   quit   working   for   the   Respondent-\nemployer   and   went   to   work   for   another   facility.   Therefore, \nRespondents  are  unaware  of  any  missed  time.  Next,  the  Claimant \nwent   from   2019   to   2021   with   no   medical   treatment.   It   is \nRespondents position that the healing period has long since ended. \n \nClaimant has also requested permanent partial disability and wage \nloss.  Respondents  are  unaware  of  any  impairment  rating  being \nassigned for the piriformis syndrome.” \n \n\nMelius – G807060 \n \n-5- \nThe claimant in this matter is a 53-year-old female who at a hearing before the Workers \nCompensation   Commission   on   April   16,   2019,   brought   a   claim   for   benefits   before   an \nadministrative  law  judge  of  the  Workers  Compensation  Commission.  Following  were  the \nstipulations and issues under consideration: \nStipulations: \n1.  The Arkansas  Workers’  Compensation  Commission  has \njurisdiction of this claim. \n \n2.  The  employee/employer/carrier  relationship  existed  on \nJuly 11, 2018. \n \n3.  The  respondents  have  controverted  the  claim  in  its \nentirety. \n \n4.  The  compensation  rates  are  at  the  maximum  and  the \naverage weekly wage is $1,469.00. \n \nIssues: \n1.  Whether  claimant  suffered  a  compensable  injury  to  her \nbuttocks and thigh on July 11, 2018. \n \n2. Whether claimant is entitled to medical treatment. \n \n3.   Whether   claimant   is   entitled   to   temporary   partial \ndisability  benefits,  from  date  of  injury  to  date  yet  to  be \ndetermined. \n \n4. Attorney fees. \n \n On  June  25,  2019,  that  administrative  law  judge  issued  an  opinion  and  found  the \nfollowing Findings of Fact and Conclusions of Law: \n1.  The  claimant  has  failed  to  prove  by  a  preponderance  of \nthe  evidence  that  she  suffered  a  compensable  injury  to  her \nright buttock and thigh  on July 11, 2018. She has failed to \nprovide evidence in the form of objective medical findings \nto  support  her  contention  that  she  suffered  spasms  related \nto the July 11, 2018, incident and alleged injury. \n \n\nMelius – G807060 \n \n-6- \n2.   The   claimant   is   not   entitled   to   temporary   partial \ndisability or medical benefits. \n \n3. The claimant’s attorney is not entitled to an attorney fee \nbased on the above findings. \n \nThat  opinion  was  appealed  to  the  Full  Arkansas  Workers’  Compensation  Commission  and  on \nDecember  19,  2019,  that  opinion  was  affirmed  and  adopted  by  the  Full  Arkansas  Workers’ \nCompensation Commission.  \n The  Full  Commission’s opinion  was  appealed  to  the  Arkansas  Court  of  Appeals  who \nreversed and remanded the case back to the Full Arkansas Workers’ Compensation Commission \non February 10, 2021. Following is a portion of that decision: \n “Accordingly, we hold that a reasonable inference from the \nchronology  of  events  is  that  the  medications,  physical \ntherapy,   and  pain  management  were  prescribed  to  aid \nMelius  and  to  treat  her  injury,  and  there  was  no  evidence \nintroduced to the contrary.  Any other construction of these \nevents  does  not  withstand  scrutiny  or  pass  the  test  of \nreasonableness.  See   Jefferson,   361   Ark.   at   265,   206 \nS.W.3d  at  243.   Fair-minded  persons  with  the  same  facts \nbefore them could not have reached the conclusions that the \nCommission   did.  The   medical   evidence   presented   by \nMelius  did  contain  objective  medical  findings  in  the  form \nof   the   observations   of   the   doctors   as   to   the   noted \ntenderness,  the  prescribed  treatment  for  muscle  spasms  in \nthe   form   of   medication,   physical   therapy,   and   pain \nmanagement.  Other determinations regarding the \ncompensability  of  the  injury  were  not  addressed  upon  the \nfinding   that   Melius   did   not   present   objective   medical \nfindings.  Therefore, we reinstate Melius’s case and remand \nfor   further   determinations   of   whether   she   suffered   a \ncompensable  injury  to  her  buttock  and  thigh  on  July  11, \n2018,  whether  she  is  entitled  to  medical  treatment,  and \nwhether   she   is   entitled   to   temporary   partial-disability \nbenefits.” \n \n The Full  Commission  then  again  received  the  case  and  issued  an  opinion  on  September \n28,  2021,  in  which  it  remanded  the  case  back  to  the  administrative  law  judge  level.  The  initial \n\nMelius – G807060 \n \n-7- \nadministrative law judge who decided the case was no longer an employee of the  Commission, \nso  the  case  was  randomly  assigned  by  the  Clerk  of  the Commission  to  a  different  judge  in  the \nappropriate  district.  Following  is  a  portion  of  the  Full  Commission’s September  28,  2021, \nremand to the administrative law judge level: \n“Having found proof by a preponderance of the evidence of \na  compensable  injury  as  documented  by  the  Court  of \nAppeals,   the   Commission   remands   this   case   to   the \nadministrative law judge for other determinations regarding \nthe  compensability  for  the  injury  which  was  not  addressed \npreviously  by  the  administrative  law  judge.  Specifically, \nthe    administrative    law    judge    shall    make    further \ndeterminations of whether claimant suffered a compensable \ninjury  to  her  buttock  and  thigh  on  July  11,  2018,  and  to \nwhat  extent  claimant  is  entitled  to  medical  treatment  and \ntemporary partial disability benefits. Therefore, this case is \nremanded  to  the  administrative  law  judge  for  proceedings \nconsistent  with  this  order  and  the  mandate  from  the  Court \nof Appeals.” \n \n On June 15, 2022, a prehearing conference was conducted. At that time the parties agreed \nto resolve the issues of compensability and medical treatment to the date of the original April 16, \n2019,  hearing.  The  only  issues  that  remained  at  that  time  were  the  claimant’s  entitlement  to \ntemporary partial disability and whether the claimant’s attorney was entitled to an attorney’s fee \nfor  that  benefit.  The  hearing  was  conducted  by  this  administrative  law  judge  on  July  21,  2022, \nwith the following stipulations and issues: \nStipulations: \n1.   The   Arkansas   Workers'   Compensation   Commission   has \njurisdiction of this claim. \n \n2.  The  relationship  of  employee-employer-carrier  existed  between \nthe parties on July 11, 2018. \n \n3.  The  claimant  sustained  a  compensable  piriformis  injury  to  the \nbuttock and thigh on July 11, 2018. \n \n\nMelius – G807060 \n \n-8- \n4.  The  respondents  have  agreed  to  pay  for  all  medical  treatment \nfrom July 11, 2018, to  April 16, 2019, regarding  the compensable \npiriformis injury to the buttock and thigh. \n \n5. The compensation rates are the maximum. \n \nIssues: \n1.  Whether  Claimant  is  entitled  to  temporary  partial  disability \nbenefits. \n \n2. Whether Claimant’s attorney is entitled to an attorney’s fee. \n \nThe opinion in that matter was issued on October 18, 2022, which stated the following Findings \nof Fact & Conclusions of Law: \n1.  The  stipulations  agreed  to  by  the  parties  at  the  pre-hearing \nconference  conducted  on  June  15,  2022,  and  contained  in  a  Pre-\nhearing Order filed July 21, 2022, are hereby accepted as fact. \n \n2.   That   the   claimant  has   proven   by   a   preponderance   of   the \nevidence that she is entitled to temporary partial disability benefits \nfrom  July  12,  2018,  until  she  began  her  new  position  with  the \nrespondents  sometime  between  September  of  2018  and  December \nof 2018. \n \n3.   That   the   claimant  has   proven   by   a   preponderance   of   the \nevidence her attorney is entitled to attorney’s fee in this matter. \n \n The claimant has asked the Commission to determine whether she is entitled to additional \nmedical  treatment  for  her  compensable  piriformis  and  right  thigh  injuries  that  occurred  on  July \n11, 2018, or alternatively, whether the claimant sustained a compensable injury to her low back \non  or  about  July  11,  2018.  On  July  31,  2019,  the  claimant  was  seen  by  Dr.  Thomas  Cheyne  at \nMercy Clinic River Valley. Following is the body of his clinic note: \nMs. Melius returns for follow up of her chronic right hip pain. She \nhad  her  MRI  scan  of  her  hip  which  was  essentially  normal  other \nthan  an  incidental  finding  of  a  left  ovarian  cyst.  She  has  a  history \nof  ovarian  polycystic  disease  so  she  is  well aware  of  the  finding \nand is seeing her gynecologist in that regard. I continue to believe \nthat this is not a lower back issue. I also do not believe that this is a \n\nMelius – G807060 \n \n-9- \nright hip joint issue but more likely muscle or tendon injury. Other \nthan  physical  therapy  and  anti-inflammatories  which  have  so  far \nnot helped, I would recommend getting her in to see Dr. Jones just \nfor a second opinion evaluation and get his ideas about the possible \nsource  of  her  pain.  We  will  schedule  that  appointment  as  soon  as \ntime is available. \n \n On  August  21,  2019,  the  claimant  was  seen  by  Dr.  Greg  Jones  at  Mercy  Clinic  River \nValley. Following is the body of his clinic note: \nMs.  Melius  is  a  49-year-old  from  Alma  who  presents at  Dr. \nBishop’s  request  regarding  right  hip  pain  and  back  pain  that  has \nbeen  going  on  since  she  had  a  patient  lifting  incident  on  7/11/18. \nShe apparently has been denied as workman’s comp. She felt a pop \nand has had pain the posterior aspect of her hip, states that she has \nhad  a “knot.”  She  has  been  treated  with  physical  therapy  for \n“piriformis  syndrome.”  She  has  been  told  by  the  therapist  on \nmultiple  occasions  that  they  can  feel  the  lump.  Physical  therapy \nseems  to  have  helped  her  get  some  motion  back  and  she  is  not  as \ntight as she  was but she  comes in  for  complaints  of her continued \nhip pain. \n \nOn  exam,  she  has  mild  to  moderate  greater  trochanteric  bursitis. \nThe  radicular  pain  symptoms  are  down  the  right  leg  and  she  has \nmild straight leg raise. \n \nI  think  that  she  has  hurt  her  back.  This  isn’t  a  piriformis  lesion. \nCertainly that can contribute to sciatic inflammation, but I think we \nneed to find out at this point, a year after the index injury, if there \nis  something  more  serious  in  terms  of  her  back  that  could  be \naddressed.  She  was  at  Chapel  Ridge  Health  &  Rehab  when  this \noccurred. Dr. Bishop is her primary medical physician. They have \nan  MRI  of  the  hip  I  have  reviewed  it  carefully.  There  is  no \nevidence of tendon avulsion, femoral acetabular arthritis, avascular \nnecrosis, or other intrinsic femoral acetabular issues in terms of the \nsource of her present discomfort. On  external rotation, the hip did \nnot reproduce her pain and while palpably she is tender posteriorly \nalong  the  tract  of  the  sciatic  nerve,  I  do  not  feel  an  actual  muscle \navulsion where the “lump” that the therapist has been so prominent \nabout. \n \nWe  will  see  her  back  when  the  lumbar  MRI  is  completed  and \nproceed  with  conservative  care  further.  Previous  lumbar  spine  x-\nrays  from  July  18\nth\n  were  reviewed.  These  are  from  2019.  She  has \n\nMelius – G807060 \n \n-10- \nstraightening  and  loss  of  the  lumbar  lordosis.  There  is  no  obvious \nlisthesis or scoliotic pattern. There is spur-type lipping anteriorly at \n4-5 and at T11-T12. Disc space heights are fairly well maintained \nbut subchondral endplate sclerosis is noted. On the foraminal outlet \nview there  appears to be facet arthropathy, interference at 4-5 and \nat  5-1.  No  fractures  and  no  destructive  lesion  evident.  No  new  x-\nrays  are  made  on  today’s  spine  films.  We  will  see  her  when  the \nMRI  is  completed.  No  additional  x-rays  need  to  be  made  at  that \ntime.  Previous  hip  x-rays  were  reviewed  and  although  she  has \nsome  calcific  density  at  the  abductor  insertion  on  the  right  hip, \nprominent greater trochanter changes, these are not consistent with \nfemoral  acetabular  arthritis.  No  leg  length  inequality  and  these \nagain are hip x-rays made in July and no new files are made. \n \n On August 28, 2019, the claimant underwent an MRI of the lumbar spine. Following is a \nportion of that diagnostic report signed by Dr. Adam Gold: \nIMPRESSION: \n1.  Central/left  paracentral  disc  protrusion  L4-5  level,  along  with \nhypertrophy  the  facets  and  ligamentum  flavum  causing  at  least \nmoderate  central  stenosis  with  probable  mass  effect  left  L5  nerve \nroot lateral recess. \n \n2.   Broad-based   central   protrusion   L5-S1   level   mild   central \nstenosis.  There  may  be  some  mild  mass  effect  left  S1  nerve  root \nlateral recess. \n \n On September 4, 2019, the claimant was again seen by Dr. Jones. Following is the body \nof that clinic note: \nMs. Melius is a  nurse at local Chapel Ridge Health & Rehab. She \nhas been on limited duty pushing a cart. She has not been engaged \nin lifting activities. She comes back for followup of her MRI. She \nhas   lumbar   stenosis,   facet   hypertrophy   and   degenerative   disc \nchanges  at  L4-5  and  L5-S1  with  disc  protrusion.  Her  symptoms \nhave improved considerably with the physiotherapy. I do not think \nshe  has  a  herniated  disc  that  requires  surgery.  We  have  talked \nabout  the  implications  of  this  level  of  back  trouble.  At  age  49  in \nterms of her body habitus, her lifting, etc., I recommended that she \nnot be lifting patients. Physical therapy will be changed to include \nspinal   flexibility   and   strengthening.   I   think   the   piriformis \nsyndrome  is  not  the  answer  but  rather  the  stenotic  phenomenon, \n\nMelius – G807060 \n \n-11- \nand given that she is this much better with therapy, surgery is a last \nresort. Lumbar epidural steroids may be of benefit. \n \nShe  has  asked  that  I  opine  as  to  its  onset.  Certainly,  the  story  she \nprovided   historically   that   she   felt   a   pop,   had   swelling   and \npresented   immediately,   this   represents   an   exacerbation   of   an \nunderlying  degenerative  disc  phenomenon  and  at  least  by  the \nhistorical  information  stated,  she  is  thankfully  better  and  I  do  not \nthink  will  require  any  surgical  intervention at  this  juncture,  but  it \nhas  lifelong  implications  which  we  have  discussed  at  length.  We \nwill  change  physical  therapy.  I  asked  her  to  do  that  twice  daily. \nHer  injury  was  in  July  2018  so  she  is  making  it  pretty  decent.  I \nthink  she  should  remain  with  a  limited  duty  status  in  terms  of \navoidance  of  patient  lifting  and  we  will  leave  her  followup  here \nopen ended. \n \n On November 23, 2021, the claimant again saw Dr. Cheyne. Following is the body of his \nclinic note: \nMs.  Melius  is  seen  back  for  the  first  time  since  I  last  saw  her  in \nJuly  2019  with  right  buttock  pain.  She  eventually  saw  Dr.  Jones \nwho  thought  that  this  was  likely  related  to  her  back.  She  had  an \nMRI  scan  done  and  had  a  left  paracentral  disk  protrusion  at  L4-5 \nand  a  central  disk  protrusion  at  L5-S1.  She  got  better  to  a  point \nwith physical therapy and anti-inflammatory medications. She also \ngot  some  relief  from  a  gluteal  injection  which  was  done  by  Dr. \nGoodman;  however,  she  has  persistent  pain.  I  have  looked  at  her \nMRI  scan  and  still  believe  that  this  is  likely  related  to  her  back, \nalthough  it  is  certainly  possible  since  she  got  relief  from  the \ninjection by  Dr. Goodman. We will get her back in to see him for \nanother  injection  or  2.  If  gluteal  injections  do  not  work,  then  we \nwill consider LESIs. \n \n The  claimant’s  request  for  additional  medical  treatment  for  her  compensable  piriformis \nand right thigh injuries is denied as no doctor has recommended any treatment for her piriformis \nand/or  right  thigh  since  July  31,  2019,  when  Dr.  Cheyne  requested  a  second  opinion  from  Dr. \nJones.  In Dr. Jones’ August 21, 2019, clinic note  he states, “I think she has hurt her back.  This \nisn’t  a  piriformis  lesion.”  The  medical  records  in  evidence  show  no  indication  of  any  medical \n\nMelius – G807060 \n \n-12- \ntreatment for the claimant’s piriformis and/or right thigh. Medical records do, however, indicate \ntreatment for the claimant’s lower back.  \n The claimant has alternatively asked the Commission to determine whether she sustained \na compensable injury to her low back on or about July 11, 2018. The claimant filed an AR-C in \nthis matter on October 16, 2018, which is found at Respondents’ Exhibit 3. The AR-C provides a \nspace  to “Briefly  describe  the  cause  of  the  injury  and  the  part  of  the  body  injured.”  The \nclaimant’s AR-C states, “Was helping lift a patient to move to another facility when felt twinge \nin buttocks. Buttocks and thigh.” \n There is no indication in the October 16, 2018, AR-C of a low back injury that she now \nclaims.  \n On  cross  examination  the  claimant  was  asked  about  her  October  16,  2018,  AR-C  and \nabout her testimony from the original April 16, 2019, hearing in this matter as follows: \nQ Ms.  Melius,  I  am  going  to  hand  you  this.  This  was  filled \nout on October 16, 2018. It is Respondents’ Exhibit No. 3 and it is \nsigned by you; is that correct? \n \nA Yes. \n \nQ And  this  would  have  been  done  after  the  date  of  injury;  is \nthat correct? \n \nA Yes. \n \nQ Okay.  Would  you  tell  me  what  body  parts  you  listed  as \nyour injury? \n \nA By buttocks and thigh. \n \nQ Okay. And you are an RN; is that correct? \n \nA No, sir. \n \nQ You are an LPN? \n\nMelius – G807060 \n \n-13- \n \nA Yes, sir. \n \nQ So  you  know  the  difference  between  low  back  and  the \nbuttocks and the thigh area. Is that a fair statement? \n \nA Yes, sir. \n \nQ Okay. As a matter of fact, at your hearing, the first hearing, \nI asked you on Page 23, “Are you claiming today that you suffered \na back injury?” Do you remember your answer? \n \nA And which date was that, sir? \n \nQ This was the first hearing. \n \nA Yes, sir. I said, “No, sir.” \n \nQ Okay. And this would have been months after the injury; is \nthat correct? \n \nA Yes, sir. \n \n The  claimant,  neither  through  the  original  hearing  in  2019  or  at  any  other  point  in \ntestimony, describes any type of injury to her lower back, only to her piriformis and right thigh; \nthe  buttock  area.  Dr.  Jones  ordered  an  MRI  that  was  performed  on  August  28,  2019,  regarding \nthe  claimant’s  low  back.  That  MRI  does  show  objective  medical  findings  of  low  back \nderangement at both the  L4-5 and L5-S1 levels.  However, the  claimant  must be able to show  a \ncausal  connection  between  those  objective  medical  findings  of  low  back  derangement  and  the \nJuly 11, 2018, incident that she alleges to have caused them.  \n Dr.  Jones  clearly  believes  the  claimant’s  difficulties  are  not  from  her  compensable \npiriformis and right thigh injury, but instead from her low back. In his September 4, 2019, clinic \nnote  he  states, “I  think  the  piriformis  syndrome  is  not  the  answer,  but  rather  the  stenotic \nphenomenon,  and  given  that  she  is  this  much  better  with  therapy,  surgery  is  a  last  resort.” \n\nMelius – G807060 \n \n-14- \nHowever,  the  claimant’s  difficulties  have  always  been  on  her  right  side.  The  MRI  of  the \nclaimant’s lumbar spine does not show any right sided stenosis. The Impressions  section states, \n“moderate central stenosis with probable mass effect left L5 nerve root lateral recess” and “mild \ncentral  stenosis.  There  may  be  some mild  mass  effect  left  S1  nerve  root  lateral  recess.”  The \nclaimant’s  low  back  issues  are  left  sided,  not  right  sided,  where  her  symptoms  have  always \nexisted.  \n Dr.  Jones’  clinic  note  of  September  4,  2019,  also  states, “Certainly,  the  story  she \nprovided historically that she felt a pop, had swelling and presented immediately, this represents \nan  exacerbation  of  an  underlying  degenerative  disc  phenomenon  and  at  least  by  the  historical \ninformation  stated,  she  is  thankfully  better  and  I  do  not  think  will  require  any  surgical \nintervention at this juncture, but it has lifelong implications which we have discussed at length.” \n The claimant’s original hearing testimony about her July 11, 2018, incident was in part as \nfollows: \nSo  I  lowered  the  bed  down  and  I  just  pushed  it  with  my \nhand  and  when  I  went  to  step,  it  was –  it’s  like  you  could  almost \nhear it, but feel it at the  same time, a popping in  my buttocks and \nmy  right  side.  And  when  I  went  to  step,  my  calf  drew  up  and  the \npain shot down my buttocks to behind my knee. \n \nSo  I  stood  there  for  a  second  and  I  rubbed  my  bottom  and \nthen  I reached down and felt my calf  which was  rock hard. And  I \nwas  rubbing  it  and  I  was  rubbing  my  bottom  and  I  thought  my \nGod.  So  then  I  tried  to  step  forward  again  and  my  leg  made  full \ncontact  and  then  it  drew  right  back  up.  So  I  stood  there  a  minute \nand kept rubbing it. Then I – \n \nQ When you say it, are you referring to – \n \nA My buttocks. \n \nQ Your buttocks. \n \n\nMelius – G807060 \n \n-15- \nA Yes. \n \nQ Was your calf muscle still – \n \nA It was drawn up. \n \nQ Spasming? Okay. \n \nA I don’t know if you would call that my calf was spasming, \nbut  it  was  just  rock  hard  from  being  drawn  up,  almost  like  a  leg \ncramp. \n \nQ When   you   mentioned   what   you   described   as   a   pop \nsensation and sound, where exactly was that? \n \nA In my right glute. \n \nAny  pop  or  swelling  heard  or  felt  by  the  claimant  was  only  in  her  piriformis  and  right  thigh  or \nbuttock  area,  certainly  not  in  her  left  lower  extremity  or  lower  back.  I  am  unaware  of  any \ntestimony  or  evidence  that  contradicts  the  claimant’s  original  testimony  about  what  occurred  at \nthe time of the injury. The claimant is unable to prove a causal connection between her July 11, \n2018, incident and the objective medical findings of low back derangement in evidence. As such, \nthe  claimant  has  failed  to  prove  she  sustained  a  compensable  low  back  injury  on  or  about  July \n11, 2018.  \nThe claimant is unable to prove that she is entitled to medical treatment for her low back \nas she is unable to prove a compensable low back injury on July 11, 2018. \n The  claimant  has  asked  the  Commission  to  determine  if  she  is  entitled  to  temporary \npartial disability benefits from September 19, 2019, to a date yet to be determined. The claimant \nis unable to prove her entitlement to temporary partial disability benefits regarding her low back \nas  she  is  unable  to  prove  her  alleged  low  back  injury  compensable.  As  previously  stated, a \nhearing was conducted in this matter on July 21, 2022, with two issues: “1. Whether the claimant \n\nMelius – G807060 \n \n-16- \nis  entitled  to  temporary  partial  disability  benefits;”  and “2.  Whether  the  claimant’s  attorney  is \nentitled to an attorney’s fee” regarding the claimant’s piriformis injury to the thigh and buttock. \nThe  opinion  filed  from  that  hearing  was  filed  on  October  18,  2022,  which  found: “2.  The \nclaimant  has  proven  by  preponderance  of  the  evidence  that  she  is  entitled  to  temporary  partial \ndisability  benefits  from  July  12,  2018,  until  she  began  her  new  position  with  the  respondents \nsometime  between  September  of  2018  and  December  of  2018;”  and “3.  That  the  claimant  has \nproven by a preponderance of the evidence that her attorney is entitled to an attorney’s fee in this \nmatter.”  The  decision  finding  temporary  partial  disability  benefits  regarding  the  claimant’s \npiriformis injury to the thigh or buttocks was not  appealed and has become res judicata and the \nlaw  of  this  case.  There  is  no  indication  in  the  medical  records  placed  into  evidence,  the  most \nrecent  of  which  is  dated  November  23,  2021,  that  the  claimant  remains  in  or  has  reentered  her \nhealing  period  at  any  time  after  July  21,  2022.  In  order  to  receive  partial  disability  benefits  the \nclaimant  must  be  able  to  prove  she  is  in  a  healing  period.  She  cannot  do  so  and,  as  such,  she \ncannot prove entitlement to temporary disability benefits. \n The  respondent  has  raised  the  statute  of  limitation  defense  in  this  matter.  Even  if  the \nclaimant  was  able  to  prove  a  compensable  injury  to  her  low  back  on  July  11,  2018,  the \nclaimant’s claim would be barred by the statute of limitations. The claimant alleges an injury on \nJuly 11, 2018, to her low back. An AR-C was filed regarding her thigh and buttocks on October \n16,  2018,  but  does  not  indicate  any  low  back  injury.  While  medical  records  in  evidence  do \ndiscuss a low back injury in August and September of 2019, the first claim made of a low back \ninjury  by  the  claimant  is  on  June  13,  2022,  when  the  claimant  filed  a  prehearing  questionnaire \nwith the Commission listing compensability of a low back injury on July 11, 2018, as an issue. \nThe statute of limitations would have barred the claimant from bringing such a claim on July 12, \n\nMelius – G807060 \n \n-17- \n2020.  The  claim  was  not  made  until  nearly  two  years  later in  the  June  13,  2022,  filing  of  the \nclaimant’s prehearing questionnaire with the Commission. \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 her demeanor, the following findings of fact  and conclusions of law \nare made in accordance with A.C.A. §11-9-704: \n FINDINGS OF FACT & CONCLUSIONS OF LAW \n 1.  The  stipulations  agreed  to  by  the  parties  at  the  pre-hearing  conference  conducted  on \nSeptember  25,  2023,  and  contained  in  a  Pre-hearing  Order  filed  October  31,  2023,  are  hereby \naccepted as fact. \n 2. The claimant has failed to prove by a preponderance of the evidence that she is entitled \nto  additional  medical  treatment  for  her  compensable  piriformis  and  right  thigh  injuries  that \noccurred on July 11, 2018. \n 3. The claimant has failed to prove by a preponderance of the evidence that she sustained \na compensable injury to her low back on or about July 11, 2018.  \n 4. The claimant has failed to prove by a preponderance of the evidence that she is entitled \nto medical treatment for her alleged compensable low back injury. \n 5. The claimant has failed to prove by a preponderance of the evidence that she is entitled \nto temporary partial disability benefits from September 19, 2019, to a date yet to be determined. \n 6. The respondents’ defense of the statute of limitations is moot in that the claimant has \nfailed to prove her low back injury compensable. \n 7. The claimant has failed to prove her attorney’s entitlement to an attorney’s fee in this \nmatter. \n\nMelius – G807060 \n \n-18- \n ORDER \nPursuant  to  the  above  findings  and  conclusions,  I  have  no  alternative  but  to  deny  this \nclaim in its entirety. \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 IT IS SO ORDERED. \n                                ____________________________                                              \n       HONORABLE ERIC PAUL WELLS \n       ADMINISTRATIVE LAW JUDGE","preview":"BEFORE THE ARKANSAS WORKERS' COMPENSATION COMMISSION WCC NO. G807060 TINA MELIUS, Employee CLAIMANT CHAPEL RIDGE NURSING CTR., Employer RESPONDENT AMTRUST NORTH AMERICA, Carrier RESPONDENT OPINION FILED FEBRUARY 27, 2024 Hearing before ADMINISTRATIVE LAW JUDGE ERIC PAUL WELLS in Fort Smith, Sebastian County, Arkansas. ...","fetched_at":"2026-05-19T22:57:49.971Z","links":{"html":"/opinions/alj-G807060-2024-02-27","pdf":"https://labor.arkansas.gov/wp-content/uploads/MELIUS_TINA_G807060_20240227.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}