{"id":"alj-G808579-2023-10-04","awcc_number":"G808579","decision_date":"2023-10-04","opinion_type":"alj","claimant_name":"Jurmicka Puckett","employer_name":"Ar. Dept. Of Corrections","title":"PUCKETT VS. AR. DEPT. OF CORRECTIONS AWCC# G808579 OCTOBER 4, 2023","outcome":"granted","outcome_keywords":["granted:1","denied:1"],"injury_keywords":["back","wrist","sprain"],"pdf_url":"https://labor.arkansas.gov/wp-content/uploads/PUCKETT_JURMICKA_G808579_20231004.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"PUCKETT_JURMICKA_G808579_20231004.pdf","text_length":47935,"full_text":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION \n \nAWCC FILE No G808579 \n \nJURMICKA PUCKETT, EMPLOYEE       CLAIMANT \n \nAR. DEPT. OF CORRECTIONS, EMPLOYER          RESPONDENT \n \nPUBLIC EMPLOYEE CLAIMS DIVISION, TPA         RESPONDENT \n \n \nOPINION FILED 4 OCTOBER 2023 \n \n \nOn  hearing  before Arkansas Workers’ Compensation Commission (AWCC) Administrative \nLaw Judge JayO. Howe, 13 April 2023, Pine Bluff, Jefferson County, Arkansas. \n \nMr. Andy L. Caldwell, Attorney-at-Law of Little Rock, appeared for the claimant. \n \nMr. Charles H. McLemore, Attorney-at-Law of Little Rock, appeared for the respondents. \n \nI.  STATEMENT OF THE CASE \n \nThe above-captioned case was heard on 13 April 2023 in Pine Bluff, Arkansas, after \nthe  parties  participated  in  a  prehearing  telephone  conference  on 24 January 2023. A \nPrehearing Order, admitted to the record without objection as “Commission’s Exhibit No 1,” \nwas  entered  on 25  January  2023. The  Order  stated  the  following ISSUES  TO  BE \nLITIGATED: \n1.    Whether   the   claimant is   entitled   to   additional medical   treatment and   pain \nmanagement. \n \n2. Whether the claimant is permanently and totally disabled. \n \n3. Whether, in the event that the claimant is not entitled to permanent and total disability \nbenefits, the  claimant  is otherwise entitled  to  benefits  under  Ark.  Code  Ann.  §11-9-\n505(a)(1). \n \n4.  Whether the claimant is entitled to corresponding attorney’s fees. \n \nAll other ISSUES were reserved. \n\nPUCKETT – G808579 \n \n2 \n \nOn  the  day  of  the  hearing,  the  parties  discussed  (as  noted  below  in  Section  III)  an \nAmended Prehearing Questionnaire Response that the claimant attempted to provide for the \npurpose  of  narrowing  the  issues before  the  Commission, better  reflecting  the  remaining \nissues since  the  filing  of  her  initial  Prehearing  Questionnaire  Responses. That  Amended \nResponse was admitted to the record as “Claimant’s Exhibit No 3”. The respondents sought \nand  were  granted  leave  to  file  an  updated Response in light of the claimant’s Amended \nResponse.  That  Response  was  tendered  on  13  April  2023  and  appears  in  the  record  as \n“Respondents’ Exhibit No 3.”  \nI found that it was in the best interest of the parties to proceed with the hearing in \nthe framing of the Amended Questionnaire Responses. Thus, the ISSUES addressed at the \nhearing, which were not inconsistent with the language of the Prehearing Order, but rather \nan extension of the issues presented therein, were: \n1. Whether the claimant was entitled to additional PPD for RSD/CRPS. \n2. Whether the claimant is permanently and totally disabled. \n3. In  the  event  that  the  claimant  is  not  entitled  to Permanent  and Total Disability \nbenefits, whether the claimant is otherwise entitled to benefits under Ark. Code Ann. §11-9-\n505(a)(1). \n4. Whether the claimant is entitled to additional medical treatment, specifically related \nto ongoing  care  from  her  PCP  Dr.  Robert  Scott,  a  neurology  consult,  and  a  referral  by  Dr. \nBrent Walker to UAMS for consideration of a Spinal Cord Stimulator. \n5. Whether the claimant is entitled to attorney’s fees. \nAll other ISSUES were, again, reserved. \nThe Prehearing Order set forth the following STIPULATIONS: \n1.  The AWCC has jurisdiction over this claim. \n\nPUCKETT – G808579 \n \n3 \n \n2.    An  employee/employer/carrier  relationship  existed between  the  parties  on  26 \nDecember  2018  when  the  claimant  sustained  an  injury  to  her  right  hand,  which  the \nrespondents accepted as compensable. \n \n3.    The claimant’s average weekly wage was $828.67, entitling her to temporary total \ndisability  and  permanent  partial  disability  in  the amounts  of  $552.00 and  $414.00, \nrespectively. \n \nThe claimant was the sole WITNESS at the hearing. \nThe parties’ CONTENTIONS, as set forth in their prehearing questionnaire responses, \nwere incorporated by reference into the Prehearing Order.  \nII.  FINDINGS OF FACT AND CONCLUSIONS OF LAW \nHaving  reviewed  the  record  as  a  whole  and  having  heard  testimony  from  the  witness, \nobserving her demeanor, I make the following findings of fact and conclusions of law under \nArk. Code Ann. §11-9-704: \n1. The AWCC has jurisdiction over this claim. \n \n2. The claimant is not entitled to additional PPD for RSD/CRPS. \n \n3. The claimant has not proven that she is permanently and totally disabled. \n \n4. The claimant has not proven entitlement to additional benefits under Ark. Code Ann. \n§11-9-505(a)(1). \n \n5. The claimant is entitled to additional treatment associated with the referral to UAMS \nordered by Dr. Walker for consideration of a Spinal Cord Stimulator. The respondents, \nhowever, are not liable for the claimant’s past treatment from Dr. Scott. \n \n6. No attorney’s fee is associated with these findings. \n \nIII.  HEARING TESTIMONY and MEDICAL EVIDENCE   \n Before the claimant testified on her own behalf, the parties discussed on the record an \namendment to the claimant’s prehearing questionnaire response  that  was  represented  as \nsent on 24 January 2023, the day of the phone conference, but not received by the Commission \nor by the  respondents’  counsel.  That amended response was  entered  on  the  record as \n“Claimant’s Exhibit No 3” and, essentially, clarified the relief sought by the claimant. [TR at \n\nPUCKETT – G808579 \n \n4 \n \n5-9].  After a short break off the record, during which the parties checked correspondence for \nthe  amended  responses,  the  proceedings  continued.  An equipment malfunction  resulted  in \npart of that back-on-the-record discussion not being captured for transcription. [TR at 9.] The \nparties  were  unaware  of  this  at  the  time,  and  the  transcript  reflects  the  end  of  that \npre-testimony  discussion  on  the  framing  of  the  issues,  relief  sought,  and  anticipated \ntestimony and argument. [TR at 9-12.] After the parties’ exhibits were marked and admitted \non the record, the claimant was sworn and her testimony began without further incident. [TR \nat 16.]                                                                                                      \nA. Claimant on Direct-Examination  \nJurmicka Puckett is a 40-year-old high school graduate with some college credit from \nthe University of Arkansas at Pine Bluff. [TR at 18.] Her employment history includes line \nwork  at  a  fish  market  and  at  Tyson.  She  began  working  for  the  Arkansas  Department  of \nCorrection (ADC) in 2004 as an entry-level corrections officer or CO I. [TR at 19.] She later \npromoted to the rank of CO II or corporal. [TR at 20.] \nExplaining her 26 December 2018 injury, she stated that another officer’s rolling chair \nmoved  out  from  under  or  around  her,  causing  her  to  fall  and  catch  herself  with  her  right \nhand.  [TR at 20-21.]  She  immediately  reported  the  injury  and  sought  treatment  at  \nMed-Express, per her employer’s direction. A  nurse  practitioner  saw  her,  assessed  a  wrist \nsprain and median nerve injury at the wrist and hand level, and entered a referral for “Any \nNeurology.” [Resp. Ex. No 1 at 4.] The claimant was eventually scheduled at OrthoArkansas, \nwhere Dr. Brian Norton saw her. [TR at 21.]  \nAccording to the claimant, she underwent X-ray and MRI scans in the next several \nweeks, with the ganglion cyst believed to be the cause of her unresolved pain. [TR at 22.] Her \npain persisted after an initial surgery on 29 April 2019. [TR at 23.] She stated that she was \nreleased  back  to  work  in  August  of  2019,  but  that  she  voluntarily  demoted  to  an \n\nPUCKETT – G808579 \n \n5 \n \nAdministrative Specialist role, consistent with a Demotion Acknowledgement form dated 11 \nJuly 2019, prior to actually returning to the workplace. [TR at 24; Cl. Ex. No 2 at 18.] The \nclaimant continued working until 3 January 2021. [TR at 25.] She stated that she quit work \nbecause, “I was still having issues with my wrist and I was dropping things....” Id. \nThe claimant testified that she presented for a second surgery on 4 January 2021, the \nday after her last day worked at ADC. She has not worked there since. Id. Nor has she worked \nelsewhere. [TR at 26.] She said that the second surgery left her in more pain than the first \none. Physical therapy was ordered, and she stated that a third surgery was planned because \nshe could not achieve strengthening in therapy because her wrist was “still in pain, and it \nwas stiff and swollen.” Id.  \nA third surgery occurred on 12 May 2021, and when asked if that procedure helped, \nshe responded, that it did not. Per her understanding of Dr. Brent Walker’s impression, she \nnow  has  complex  regional  pain  syndrome  or  CRPS  in  her  wrist.  [TR  at  27.] The  claimant \nstated  that  Dr.  Norton  referred  her  to  Dr.  Walker  and  sent  her  for  a  Functional  Capacity \nEvaluation (FCE). Id. She testified about performing her best effort at the FCE, but that she \nsought Dr. Norton’s care again immediately after the testing because of pain and swelling in \nher  hand.  She  appeared  to  claim  that  around  that  time  she  also  experienced  or  began \nexperiencing “aching that goes up the arm.” Id. Dr. Norton, she said, referred her back to Dr. \nWalker, whom she last saw in July of 2022. [TR at 28.] \nAccording to the claimant, Dr. Walker advised that a spinal cord stimulator was the \n“only other option... because it was at its chronic state.” Id. The respondents did not authorize \nimplantation of the stimulator. Nor did they authorize additional treatment from that point. \nShe stated, however, that her pain and problems with her right hand persist and that she \npresents at various times to her neighborhood clinic for ice packs. Id. \n\nPUCKETT – G808579 \n \n6 \n \nSince Dr. Walker’s care ended, she has seen and continues seeing her PCP, Dr. Robert \nScott at  the  Daughters of  Charity clinic.  [TR  at  29.] She said that Dr.  Scott  is prescribing \nGabapentin tablets and Diclofenac ointment for her wrist and hand. [TR at 30.] The claimant \nsaid she avoids taking Gabapentin if she knows she is going to be driving; it makes her dizzy \nand drowsy. Otherwise, she takes it three (3) times daily. According to the claimant, Dr. Scott \nhas restricted her from working with her right hand. Id. \nMs. Puckett applied for unemployment benefits, but that was denied. [TR at 32.] She \nalso applied for Social Security Disability (SSD) and listed an arm injury, diabetes, high blood \npressure, and high cholesterol as her disabling conditions. That application was also denied, \nbut she stated that she is appealing that denial and adding vertigo to her list of conditions. \nId.  She stated that she would like to return to work, but that she “can’t do the job essential \nfunctions that I require.” [TR at 33.] Explaining further, she said: \nJust any kind of motioning of the hand, any kind of rotating, pulling, \nany kind of—even trying to write with the right hand, it’s just, I no longer can \njust do it. I’m learning to write with the left hand... any kind of rotating the \nwrist causes pain up the arm.  Id. \n  \n She  wears  a  brace  or  splint  with  a  cushion  that  extends  up  her  forearm  that  was \nprescribed  by  Dr.  Norton.  [TR  at  34-35.]  When  she  experiences  discomfort  or  pain,  the \nclaimant  applies  cold  or  heat,  tries  massage  and  more  Gabapentin,  or  she  presents  to  the \nclinic where they apply cold packs and wrapping from the wrist up her arm. She opined that \nshe cannot do any of the jobs she previously worked because she cannot write or type, pick \nup boxes or books, or push buggies. [TR at 36.] She also believes that she could not perform \nwork while taking Gabapentin because of the drowsiness she experiences with it. [TR at 37.] \nMs. Puckett stated that she can drive to Dr. Scott’s clinic because it is not far away from her \nhouse. Still, she tries to avoid the medication if she will be driving. [TR at 38.] If she presents \n\nPUCKETT – G808579 \n \n7 \n \nto the clinic in pain and not having already taken Gabapentin, she may receive a Tramadol \ninjection that Medicaid pays for. [TR at 38.] \n B.  Transcription Issue \n At the conclusion of Ms. Puckett’s testimony on direct-examination, the parties briefly \nwent off the record. [TR at 39.] During the break the Court Reporter found an earlier problem \nwith the recording equipment left part of the pre-testimony discussion out of the record. See \nabove. The narrative around that issue and the parties’ opportunity to relay information or \nargument related thereto appear in the Transcript between pages 39 and 43. As noted above, \nthe parties were discussing claims and positions, but no witness testimony or evidence was \nlost. The actual presentation of the witness’ evidence was not impacted, and neither party \nmoved for any dispositive action based on the malfunction. \nC.  Claimant on Cross-Examination by Mr. McLemore \nIn response to a question by counsel, the claimant explained that she chose to wear a \ncushion around her waist to help keep her splint and wrist propped up and that the cushion \nwas not prescribed by a physician. [TR at 43.] \nThe claimant agreed that the records reflected that while she was out on FMLA, she \ninterviewed for and received a promotion from Mail Room Services Coordinator to Mail Room \nSupervisor. [TR at 46; Cl. Ex. No 2 at 9-13.] She stated that she, however, did not return to \nwork as the mail room’s supervisor [TR at 46.] Ms. Puckett also acknowledged that she signed \nfor a Form AR-N after reporting her injury. [TR at 47.] \nThe claimant acknowledged that the Nerve Conduction Study performed in June of \n2022 was reported by Dr. Rodrigo Cayme as “within normal limits, with no evidence of right \nmedian or ulner mononeuropathy.” [TR at 49.] She discussed her other, pre-existing health \nconditions  and  some  complications  related  to  managing  or  treating  those  conditions. \n\nPUCKETT – G808579 \n \n8 \n \nAccording  to  the  claimant,  she intends\n1\n for  a  neurologist  to  see her about  headaches  she \nattributes to her wrist or hand pain and for the vertigo she was experiencing. [TR at 52-53.] \nMs.  Puckett  denied  any  relief  from  any  surgery  or  from  Dr.  Walker’s intervention: \n“I’ve gotten no relief.” [TR at 54.] And she stated that she cannot write with her right hand. \nId. Despite her discomfort, she offered that she performed her best at the FCE. [TR at 55.] \nDiscussing the  various medications she  had  been  prescribed  or  tried  at  one  time  or \nanother, the claimant said that she told Dr. Walker that Gabapentin made her sleepy and \ndizzy. [TR at 59.] She disagreed with Dr. Walker’s 15 September 2021 note stating that she \nreported not being able to take Gabapentin due to severe nausea and vomiting. See Resp. Ex. \nNo 1 at 73. She testified, instead, that Amitriptyline made her sick, not Gabapentin. [TR at \n59.] \nThe  claimant  denied  seeing  Dr. Norton  again after  the  FCE,  but  she  did  see  Dr. \nWalker, who ordered stellate ganglion blocks. Dr. Walker then released her on 28 October \n2021. [TR at 62-63.] She said that her employment terminated on 29 October 2021. She said \nthat  she  continues  seeking  treatment  for  resolution  of her symptoms. Dr. D’Orsay Bryant \nsaw  her  and  ordered  an  X-ray,  but  did  not recommend  surgery  at  the  time.  At  some  point \nthereafter, she saw Dr. Baskin on her own. [TR at 64.] She denied being ready to go back to \nwork at or around that time because she had not been released by her PCP, Dr. Scott, whom \nshe  said  she  saw immediately  after  her  injury  occurred.  The  claimant  testified  that  she \ncontinued  seeing  Dr.  Scott  for  her  injury  at  the  same  time  she  was  seeing  Drs.  Norton, \nWalker, and Bryant. [TR at 65.] \nRegarding  her  returning  to  work,  Ms.  Puckett  said  that  she  called  someone  after \ncompleting the FCE to ask about jobs within her restrictions. [TR at 66.] “I asked her, ‘Did \n \n1\n At the time of the hearing, the claimant indicated a neurology appointment was already scheduled \nfor 11 June 2023. [TR at 53.] \n\nPUCKETT – G808579 \n \n9 \n \nthey find any job that was within my restrictions?’ and she said, ‘No.’ The only thing that she \nsaying was, ’25 pounds,’ but they already terminated my position.” Id.  She  acknowledged \nreceiving  a  letter  from  Rebecca  Thomas  dated  14  January  2022,  but  denied  (as  was \napparently offered to her in the letter) meeting with Ms. Thomas to discuss returning to work. \n[TR at 67.] She was asked again and verified that she did not meet or contact her employer \nabout returning to work around that time or after the 14 January 2022 letter. \nThe  claimant  testified  that  she  wanted  to  go  back  to  work  in  October  of  2021,  but \n“could not go back” when ADC was seeking to bring her back in January. \nQ:  But January the 14\nth\n of 2022, you did not want to go back? \n \nA:    I  could  not  go  back,  due  to  I  had  went  to  the  doctor  to  get – \nunderstand things had progressed, things had changed, and I had been going \nto Dr. Robert Scott. My doctor had been following up with me versus the other \ndoctors  really  not  following  up,  basically, saying that I met MMI. There’s \nnothing else they could do for me. From a surgical standpoint, I was as good as \nI was going to get. So I followed up with my doctor, Robert Scott, because I’m \nstill  having  the  same  issues,  still  having  the  same  problems.  And  once  he \nevaluated me and seen the issues or whatever, to seeing whatever records that \nhe has; so it won’t be hearsay, he advised that I was not to return to work. \n \nQ:  So between October and January, what changes is your advice from \nyour family doctor not to work? \n \nA:  Not to work. That’s according to Robert Scott. \n \nQ:  Okay. Who you’ve been seeing all along, while you had seen Dr. \nNorton, Dr. Walker, and Dr. Bryant? \n \nA:  Yes, because I hadn’t received any medical treatment prior to – I \nmean, after the accident.  [TR at 68-69.] \n \n The claimant went on to say that she is not seeking any employment, although she \napplied for  a  job  at Dollar General,  as  part  of her  unemployment  application  process,  that \nshe admits was outside of her physical abilities. [TR at 69.] Her unemployment application \nwas denied, and she filed for Social Security Disability sometime in January of 2022. [TR at \n70.] \n\nPUCKETT – G808579 \n \n10 \n \n According to the claimant, she saw Dr. Norton again in May of 2022, after seeing Dr. \nBaskin.  Dr.  Norton,  she  said,  referred  her  back  to  Dr.  Walker. Id.  She  recalled  the  nerve \nconduction study performed in June of 2022 and following up with Dr. Norton afterwards. \nDr.  Norton  also  ordered  a  bone  scan,  after  which  he  saw  her  one  more  time  without \nrecommending further treatment or intervention. [TR at 71.] She then saw Dr. Walker again, \nand he did not prescribe any medication. The claimant said that “the only other option I had \nwas to have a stimulator,” which “should be able to help with the pain.” [TR at 72.] She has \nnot  seen  Dr.  Walker  since  that  visit.  Dr.  Scott  is  the  only  physician  who  has  followed  her \nsince then.  \n Ms.   Puckett   confirmed   that   she   is   not   currently   looking   for   work   at   the \nrecommendation of Dr. Scott, because her wrist is “at its fracturing point” and “can be easily \nfractured just getting a little bump.” So she mostly spends her time at home. [TR at 75.] \nD.  Claimant on Additional-Examination \nThe  claimant  addressed  additional  questions  again  about  prescription  medications \nand  treatments  that  she  found  unhelpful.  She  said  that her  PCP, Dr.  Scott, continues  to \nprescribe her Gabapentin and that he thinks she should see a neurologist. [TR at 82.] \n E.  Medical Evidence \n Ms. Puckett first sought treatment on for her wrist 26 December 2018, the day she \nwas  injured. See, [Cl. Ex. No 1 at 1-6.] The  provider  assessed  an  unspecified  sprain  with \nnegative X-ray findings. She was taken off work with a follow-up scheduled for a few days \nlater. The claimant presented again on 28 December 2018, complaining of throbbing pain. Id. \n[at 7-10.] She was assessed with a median nerve injury at the wrist, continued off work, and \nreferred to a specialist. \n\nPUCKETT – G808579 \n \n11 \n \n The claimant then presented to Dr. Brian Norton\n2\n on 11 January 2019. He assessed \nher pain as possibly due to a ligament or tendon injury versus a contusion and ordered an \nMRI. Id. [at 17.] She saw Dr. Norton again, and his 8 February 2019 encounter note states \nthat  the  MRI  revealed  a  ganglion  cyst,  which  he believed  was  likely  related  to  her  work \ninjury. Excision was discussed and scheduled. Id. [at 18.] The MRI did not reveal any acute \nor suspicious findings in the claimant’s hand. Id. [at 22-23.] \n Dr. Norton removed the cyst on 29 April 2019 without complication. Id. [at 25.] She \nfollowed up with him on 15 May 2019, when he ordered the initiation of occupational therapy \nand  authorized  her  return  to  work  that  day  with  a  five-pound  pushing/pulling/lifting \nrestriction  for  her  right  hand. Id. [at  27-33.] Due  to  some apparent  confusion  about \nscheduling, she did not begin a regular course of therapy appointments until 10 June 2019. \nId. [at 34.[ Ms. Puckett followed up with Dr. Norton’s physician assistant Jenna Pardoe on \n19 Juley 2019. Id. [at 69-74.]  The encounter note indicates she was improving, should follow \nup  again  in  a  month,  and was  to  return  to  work  with  a  15-pound  pushing/pulling/lifting \nrestriction for her right hand.  \n Ms.  Puckett  saw  Dr.  Norton  again  on  6  August  2019,  when  she  complained  of \ncontinuing pain and popping in her wrist. He ordered another MRI for further evaluation of \nthe  wrist  and  placed  her  on  a  20-pound  restriction. Id. [at  78-83.] The  claimant  was  seen \nagain on 10 September 2019. Id. [at 84-87.]  The MRI revealed no new abnormality. The note \nindicates  no  significant  pain,  but referenced additional  treatment  options should  the  need \narise. The note further reflects “no impairment per exam today.” She was placed at MMI and \nreleased to work without restrictions at full duty, with follow up on an as-needed basis. Id. \n[at 85.] \n \n2\n According to the OrthoArkansas website, Dr. Norton is an orthopaedic surgeon specializing in hand \nand upper extremity surgery. See https://www.orthoarkansas.com/briandnortonmd. \n\nPUCKETT – G808579 \n \n12 \n \n After about a year, Ms. Puckett presented to Dr. Norton’s clinic again on 1 September \n2020 with continued complaints of pain and popping in her right wrist. See,  [Resp. Ex. No 1 \nat 22.] An MRI was ordered, and her work status was continued at full duty. Id. [at 24.] The \n7 October 2020 MRI revealed no ganglion recurrence, but some synovitis. Id. [at 25-28.] Dr. \nNorton consulted with her on treatment options and performed a steroid injection that day. \nShe was instructed to monitor her blood sugar and to follow up on 18 November 2020. \n The   claimant   returned   for   the   November   appointment   and   reported some \nimprovement  with  her  pain,  but  that  her  blood  sugar  levels  became  significantly  elevated \nafter  the  steroid  injection. Id. [at  29-31.] The  record  notes she  “has  failed  nonsurgical \ntreatment and is unable to proceed with repeat injection. The patient has elected to proceed \nforth with a right wrist arthroscopy and partial synovectomy....” That procedure (a right \nwrist   arthroscopy   with   triangular   fibrocartilage   complex (TFCC) repair   and   partial \nsynovectomy) occurred without complication on 4 January 2021. Id. [at 32-35.] \n She followed up with Dr. Norton’s office on 7 April 2021, when some pain and clicking \nwere   still   noted. Id. [at   41-44.] She   was   authorized   to   return   to   work   without \npushing/pulling/lifting with her right hand. A repeat MRI was ordered and performed on 27 \nApril 2021. Id. [at 45.] The claimant saw Dr. Norton again 27 April 2021. See,  [Cl. Ex. No. 1 \nat 91-94.] His note for that visit reflects: \nMRI showed findings consistent with the postoperative TFCC repair changes. \n. . . \nPatient has intact flexion extension of wrist, however this is limited secondary \nto pain. \nThere is palpable clicking noted along the dorsal and ulnar aspect of the wrist \nspecifically  with  wrist  flexion,  radial  deviation  as  well  as  supination  and \npronation. \nFull motion in the fingers. \n. . .  \nThe patient continues to have significant pain and clicking in the wrist. I do \nnot believe there is anything else I can really offer her other than a revision \narthroscopy to see if there is any other derangement within the wrist that has \ndeveloped.  If  the  wrist  arthroscopy  is  relatively  normal  [then]  I  would \n\nPUCKETT – G808579 \n \n13 \n \nrecommend  proceeding  forth  with  a  functional  capacity  evaluation.  The  risk \nand benefits of surgery were explained to the patient. Risks include but are not \nlimited   to   bleeding,   infection,   damage   to   nerves   or   vessels,   need   for \nreoperation,  stiffness,  continued  pain,  and  the  development  of  CRPS/RSD. \nThey voiced understanding of these risks and elected to proceed with surgery. \nWe will keep her on the same work restriction.  Id. \n   \n The revision was performed on 12 May 2021 without complication. Id. [at 96-97.] The \nTFCC repair appeared healed, but significant synovitis was observed again and addressed \nvia partial synovectomy. Additional OT began on 25 May 2021. Id. [at 98-102.] \n At a follow-up with Jenna Pardoe in Dr. Norton’s office on 22 June 2021, some range \nof  motion  improvement  was  noted  along  with  mild  wrist  pain. Id. [at  125-128.] Her  anti-\ninflammatory   medication   was   changed   and   her   work   restriction   was   placed   at   no \npushing/pulling/lifting with the right hand of more than five (5) pounds. Ms. Puckett saw Dr. \nNorton again on 3 August 2021, and his note from that visit reflects: \nShe continues to have significant pain in the wrist as well as stiffness in the \nhand. She is also complaining of pain in the forearm. \n. . .  \nSome mild wrist pain with range of motion. She also complains of some vague \nforearm pain. \n. . .  \nAt this point the patient does continue to have pain and stiffness in the hand \nas  well  as  in  the  forearm.  Not  sure  there  is  anything  I  can  offer  her  from  a \nsurgical   standpoint.   I   would   recommend   getting   a   functional   capacity \nevaluation   for   permanent   restrictions. In   the   meantime   I   would   also \nrecommend a referral to either Dr. Walker or Frankowski for evaluation. We \nwill  await  their  evaluation  and  the  FCE  to  determine  further  treatment \noptions.  Id. [at 185-188.] \n \n Ms. Puckett then saw Dr. Norton’s practice partner Dr. Brent Walker\n3\n on 13 August \n2021. Id. [at  189-194.] His  initial  assessment  included  Complex  Regional  Pain  Syndrome \nType 1 meeting Budapest criteria upper extremity. He ordered a triple phase bone scan and \nbeginning a series of Stellate Ganglion Blocks (SGBs). The bone scan was performed on 23 \n \n3\n According  to  the  OrthoArkansas  website,  Dr.  Walker  is  an  anesthesiologist  specializing  in \ninterventional pain management. See https://www.orthoarkansas.com/brent-walker-md-1. \n\nPUCKETT – G808579 \n \n14 \n \nAugust  2021,  and  the  radiologist’s  impression  was  listed  as  Complex  Regional  Pain \nSyndrome. Id. [at 195.] The SGB injections were performed between 24 August 2021 and 7 \nSeptember 2021. Id. [at 196-198.] \n Her next office follow-up with Dr. Walker was on 15 September 2021. Id. [at 199-203.] \nAccording to that note: \n She has not noticed much improvement following these injections. She \nhas been dealing with this pain for 9 months now. I am somewhat concerned \nthat  we  may  have  missed  her  window  of  opportunity  with  stellate  ganglion \nblocks. She still has focalized pain along the ulnar aspect of her palm. She has \nan  area  of  point  tenderness  she  can  press  on  causes  severe  pain  around  her \nthumb. Her right hand is still slightly swollen as compared to her left. She has \ntrouble gripping items and especially turning doorknobs. She is unable to take \nthe gabapentin due to severe nausea and vomiting. She is taking amitriptyline \nand clonidine. [Claimant disagrees with Dr. Walker’s comment here about her \nnot  tolerating  Gabapentin  and  discussing the other  medications she  was \ncontinuing.] \n. . . \nComplicating matters since we began the injections her blood sugars have been \nin the 400s. I do not have a good explanation for this other than stress reaction. \nThe injections do not contain any steroid which would be a possible reason for \nthese elevated blood sugars. Her primary care doctor has suggested we pause \nthe SGBs until she gets her blood sugar under control. \n. . . \n[CPRS] is a chronic condition which varies from person to person. And some \nsigns and symptoms go into spontaneous remission. It is possible for CPRS to \nreactivate months or even years after the initial insult. \n. . . \nWe will pause the [SGBs] until she gets her blood sugar under control. \n. . . \n \n The following week, Ms. Puckett presented for the FCE ordered by Dr. Norton. See, \n[Resp. Ex. No 1 at 76-95.]  According  to the report,  her effort was  reliable.  Her  limitations \nwere listed as “bi-manual lift/carry of up to 45 pounds,” maximal RUE unilateral lift of 20 \npounds  versus  25  pounds  with  the  LUE,  a  5-pound  limit  while  occasionally  reaching,  and \nmildly decreased grip strength in her right hand. “She performed all other activities at a level \nconsistent with that of an average worker.” The report concluded that, as defined by the US \n\nPUCKETT – G808579 \n \n15 \n \nDepartment of Labor’s guidelines, she was able to perform in the medium  classification  of \nwork. \n The claimant saw Dr. Walker again on 14 October 2021. See, [Cl. Ex. No 1 at 211-215.] \nShe stated that her blood sugars were better controlled, but that she was continuing to have \ntrouble with pain since stopping the SGBs and that she was experiencing notable sleepiness \nbecause of her medications. Dr. Walker ordered the SGB injections to begin again. \n On 28 October 2021, Dr. Norton authored a letter assigning Ms. Puckett a permanent \nimpairment  rating. Id. [at  216.] He  placed  her  at  MMI  and  adopted  the  work  limitations \nnoted in the FCE. Based on the AMA Guides to the Evaluation of Permanent Impairment, \n4\nth\n Ed., he assigned an impairment rating of the right wrist of eleven percent (11%) and of \nthe whole person at seven percent (7%). That rating was made with a reasonable degree of \nmedical certainty. \n The claimant then sought the opinion of Dr. D’Orsay Bryant, another orthopaedic \nsurgeon. Id. [at 217-219.] According  to  his 24  November  2021 exam note, “[t]he patient \nfurnished me hundreds of pages of her past medical record, which I have read over a dozen \ntimes.  The  treatment  rendered,  by  both  Dr.  Norton  and  Dr.  Walker,  is  satisfactory  and \nmedically indicated.” He found that the “patient does have a complex regional pain syndrome \nthat is extraordinarily difficult to treat” and agreed with Dr. Walker’s assessment  of  the \nchronicity of her condition. Dr. D’Orsay went on to state that “there are simply no further \neffective  treatment  recommendations that I can offer for the patient’s right wrist complex \nregional  pain  syndrome. The  patient  does  have  a  painful  right  wrist  disorder,  and  in  the \nfuture, a pain management program may be a treatment protocol consideration to address \nthe complex regional pain syndrome.” Id. \n\nPUCKETT – G808579 \n \n16 \n \n There is a gap in the medical records offered by the claimant between Dr. D’Orsay’s \nNovember 2021 exam and a visit with Dr. Walker in July of 2022. The respondents, however, \nprovide additional records for that time. \n On  24  January  2022,  ADC  sent  an  Essential  Job  Function  Questionnaire  to  Dr. \nD’Orsay.  He  faxed  a  response  that  same  day  stating,  “I  declined  to  recommend  any \northopaedic treatment, so I do not know her work status/restrictions.” See, [Resp. Ex. No 1 at \n105-106.] \n She  saw  Dr.  Norton  again  on  10  May  2022. Id. [at  107-111.] She  presented  with  a \nwalker,  stating  that  she  had  seen  Dr.  Barry  Baskin  and  that  he  recommended  a  nerve \nconduction study. Dr. Norton noted her history and continued symptoms. He ordered a nerve \nconduction  study/EMG and that she  remain  on  the same  work restrictions  as  noted  in the \nFCE. \n The claimant saw Dr. Rodrigo Cayme\n4\n on 21 June 2022 for the nerve conduction study. \nId. [at  112-119.] The  findings  were  all  within  normal  limits,  with  no  evidence  of  electrical \ninstability. \n Ms.  Puckett  returned  to  Dr.  Norton  again  on  21  June  2022. Id. [at  120-126.] He \nreviewed  the  normal  study  results  with  her  and  opined  that  he  had  little  to  offer  from  a \nsurgical standpoint. Another triple phase bone scan was ordered. That scan was conducted \non 27 June 2022 and returned a negative study with “no scintographic evidence of complex \nregional pain syndrome.” Id. [at 127-128.] \n On  7  July  2022,  Dr.  Norton  responded  to  a  case  management  letter  regarding  Ms. \nPuckett’s course. He confirmed she reached MMI on 21 August 2021, that her impairment \n \n4\n According  to  the  OrthoArkansas  website,  Dr.  Cayme  is  a  Physical  Medicine  and  Rehabilitation \nspecialist with a fellowship in interventional spine medicine. See \nhttps://www.orthoarkansas.com/rodrigocaymemd. \n\nPUCKETT – G808579 \n \n17 \n \nrating was unchanged, and that her work status (as previously authorized by him) had not \nchanged. Id. [at 129-131.] She then returned to Dr. Norton’s office on 25 July 2022, when he \nnoted the recent negative bone scan and that he was unsure of the etiology of the pain. He \nreferred her to Dr. Walker again. Id. [at 132-136.] \n Dr. Walker then saw her on 27 July 2022. See,  [Cl Ex. No 1 at 222-228.] He noted her \nhand  was  stiff,  painful,  and  looked  “terrible.”  He  recounted  her  course and  continued \ndifficulty, concluding, “[a]t this month her condition [has] existed for well over a year and a \nhalf. I think she is most likely in the chronic phase of this condition. I do not think any further \nstellate ganglion blocks or medications will be of benefit. I am going to refer her to UAMS for \nconsideration of a spinal cord stimulator.” Id. at 225. Dr. Walker referred her to Dr. Erika \nPeterson at UAMS. Id. at 220. \n The claimant appears to have presented to the JRMC Emergency Department on 16 \nAugust 2022, as evidenced by a radiology report provided in her medical exhibit. See, [Cl. Ex. \nNo 1 at 230.] The exhibit is a photo of a record indicating it is page three of three. The first \ntwo pages of the report and any associated clinic notes are not included. The impressions for \nwhat appear to be X-Ray imaging of the humerus and right hand are negative but for some \nmild  periarticular  osteopenia  in  the  right  hand.  A  nuclear  medicine  bone  scan  on  27  June \n2022 and CRPS are listed, respectively, for comparison and indication. Id.   \n After Dr. Walker’s referral to UAMS, Dr. Norton appears to have been provided with \nan Essential Job Function Questionnaire from the respondents. He completed that form on 3 \nOctober 2022, indicating no restrictions or limitations. Id. at 144. Neither the claimant nor \nthe respondents provided a progress note or record from an office visit associated with the \nquestionnaire. \n\nPUCKETT – G808579 \n \n18 \n \n The claimant provides several additional records from her PCP’s clinic. Id. [at  233-\n258.] She acknowledged at the hearing that this treatment was not authorized. Those records \ninclude  a  work  note  from  her  PCP  Dr.  Robert  Scott,  dated  5  January  2023,  that  does  not \nappear to correspond to any particular office visit. Id. [at 238.] The note states that she cannot \nwork due to her inability to use her right hand and that she was seeking further treatment. \nIV.  ADJUDICATION \n The  stipulated facts are  outlined  above. It  is settled that  the  Commission, with the \nbenefit of being in the presence of the witness and observing his or her demeanor, determines \na witness’ credibility and the appropriate weight to accord their statements. See, Wal-Mart \nStores, Inc. v. VanWagner, 337 Ark. 443, 448, 990 S.W.2d 522 (1999).   \nA.  The Claimant is Not Entitled to Additional PPD for RSD/CRPS. \n \nThe claimant seeks additional PPD related to her RSD/CRPS diagnosis. The claimant, \nhowever, failed to meet her burden on refuting the appropriateness impairment rating issued \nby  Dr.  Norton  on  28  October  2021.  Nor  did  she  present  evidence  that  the  PPD  benefits \nassociated  with  that  rating  have  not  been  paid  accordingly.  The  claimant,  thus,  failed  to \nprove, by  a  preponderance  of  the  evidence, that  she  is  entitled  to  additional  PPD  benefits \nassociated with her wrist specific to the RSD/CRPS diagnosis and separate and beyond the \nrating already stated within a reasonable degree of medical certainty. \nPermanent  impairment  is  any  permanent  functional  or  anatomical  loss  remaining \nafter the healing period has ended.  Any determination of the existence or extent of physical \nimpairment  must  be  supported  by  objective,  measurable  medical  evidence. See, Walker  v. \nFresenius  Med.  Care  Holding,  Inc.,  2014  Ark.  App.  322, *12; 436  S.W.3d  164,  **171;  2014 \nArk.  App.  LEXIS  426, ***17  (citations cleaned  up).  Permanent  benefits  are  to  be  awarded \nonly  following  a  determination  that  the  compensable  injury  is  the  major  cause of  the \ndisability or impairment, with a “major cause” being established, by a preponderance of the \n\nPUCKETT – G808579 \n \n19 \n \nevidence, as to meeting more than fifty percent (50%) of the cause. Ark. Code Ann. §§ 11-9-\n102(F)(ii),  11-9-102(14).  Any  medical  opinion  offered  must  be  stated  within  a  reasonable \ndegree of medical certainty. Ark. Code Ann. § 11-9-102(16). \nHere,  we  have  a  claimant  who  received  a  permanent  impairment  rating  and  no \nevidence that benefits were not paid according to that rating. I do not find a preponderance \nof evidence to support a finding that Dr. Norton’s 28 October 2021 is insufficient or requires \nadjustment.  His  rating  assignment  contemplated  the  FCE,  which  put  her  in  the  Medium \nwork classification, and he found her to be at MMI. There is no evidence that this rating was \nnot  based  on  any  of  his  own  treatment  or  the  other  relevant  records  available  to  him, \nincluding her earlier visit with Dr. Walker, who saw her upon referral from Dr. Norton and \nwho assessed CRPS and noted that condition’s tendency to go into remission and reactivate. \nDr. Norton’s rating was made within a reasonable degree of medical certainty. \nFurther,  Dr.  Norton  responded in  July  of  the  following  year to  a  case  management \nletter regarding  Ms.  Puckett’s  course.  He  confirmed that  she  reached  MMI,  that  her \nimpairment rating was unchanged, and that her work status had not changed. There is no \nevidence that the notes and reports from claimant’s additional treatment with Dr. Walker \nwere not  available  to  Dr.  Norton  for  his  drafting  of  that  letter.  I  do  not  find  the \nunaccompanied (by  way  of  no  associated  office  visit  notes) and  unsupported (by  way  of  no \nreference to any previous provider notes, imaging studies, or FCE report) note from Dr. Scott \nto be persuasive in justifying any adjustment in the claimant’s rating or permanent benefits \nowed. \nAccordingly, the claimant fails to prove, by a preponderance of the evidence, that she \nis entitled to additional PPD benefits for CRPS/RSD. \nB.  The Claimant Has Not Provent that she is Permanently and Totally Disabled. \n \n\nPUCKETT – G808579 \n \n20 \n \nArkansas law defines “Permanent Total Disability” as the inability,  because  of  a \ncompensable  injury,  to  earn  any  meaningful  wages. And  the  employee  has  the  burden  of \nproving that inability to earn wages. Ark. Code Ann. §§ 11-9-519(e)(1-2). \nThe claimant said that she would like to return to work, “but I just know that I can’t \ndo the essential job functions....” [TR at 33.] What  essential  functions  of  what  job  has she \nshown she cannot perform? The FCE, which found her effort reliable, placed her at a medium \nclassification.  She  refused  to  attempt  to  return  to  her  job  with  the  respondents since  her \nsecond surgery and refused to cooperate in finding some other job with the defendants. By \nher own admission, the only job she applied for was one at Dollar General. “I know I couldn’t \ndo the job,” but to get the unemployment benefits she was seeking, she said, “you have to \napply for it, because – try to apply for a job, and that’s what I did.” [TR at 69-70.] \nOn taking Gabapentin (apparently for years now), Ms. Puckett stated “it’s gonna put \nme to sleep,” but “that’s just what I’ve been taking.” [TR at 37.] To the extent that she may \nassert  that  Gabapentin  essentially  disables  her,  she  produced  little  evidence  of  any \ncoordinated effort to better manage her medication or its effects. The claimant discredits Dr. \nWalker’s note about reporting Gabapentin making her sick. She cites Dr. Scott, whose \nunauthorized  treatment  went  on  outside  the  coordination  of  Dr.  Walker and  Norton’s \ncollaborative efforts, as her prescribing physician for Gabapentin. Even if Gabapentin were \nthe  only  medication  available  to  provide  her  with  relief,  she  produced  no  evidence  of  any \neffort  to  perform  in  the workplace only to  find  it  difficult.  Nor did she  produce evidence of \nworking with Dr. Scott working with her to find a different medication or dosing schedule to \nmitigate her concern about drowsiness. \nThe claimant is forty (40) years old with years of knowledge of prison operations and \nwith administrative knowledge and experience. I do not find her motivated to return to any \n\nPUCKETT – G808579 \n \n21 \n \nwork, and I give credit to the records reflecting her ability to work with restrictions over Dr. \nScott’s assertion that she cannot work at all because of difficulty with her right hand. \nBased on the record before me, I cannot find that Ms. Puckett is completely unable to \nparticipate  in  the  workforce. Accordingly,  I  do  not  find  that  she  has  proven, by  a \npreponderance  of  the  evidence, that  she  is  totally  and  permanently  unable  to  earn  wages. \nHer claim for Permanent and Total Disability Benefits is, therefore, denied. \nC.  The Claimant Has Not Proven Entitlement to Additional Benefits Under Ark. \nCode Ann. § 11-9-505(a)(1). \n \nUnder Arkansas law, an employer “shall be liable to pay to the employee the difference \nbetween benefits received and the average weekly wages lost” when an employer refuses to \nreturn an injured employee to work when employment is available within the employee’s \nwork limitations.  Ark. Code Ann. § 11-9-505(a)(1). The claimant seeks benefits under this \nstatute in the event that she is not found permanently and totally disabled. The respondents \nargue,  in  part,  that  this  claim  is  inconsistent with  her position  that she  is  unable  to work \naltogether. They also argue that the claimant refused to return to work and even refused to \nengage in an interactive process to discuss returning to work when the respondents sought \nthe same. \nThe  claimant  fails  to  prove she  is entitled  to  any  benefits  on  this  claim.  Working \nthrough the argued inconsistency of the two positions is not necessary. By the claimant’s own \ntestimony, she refused to cooperate with the respondents to discuss her returning to work. \nDespite  her  release  to work from Dr. Norton, she says she relied, instead, on Dr. Scott’s \nopinion that she should not work altogether. The record includes no persuasive evidence that \nshe was actually inclined to return to work for the respondents, but somehow thwarted by \ntheir refusal to permit or coordinate that. Her claim for these benefits fails accordingly. \nD.  The Claimant Is Entitled to Additional Reasonable and Necessary Medical \nTreatment and/or Pain Management. \n\nPUCKETT – G808579 \n \n22 \n \nArkansas  law  requires  an  employer  to  promptly  provide  for  medical  treatment  and \nsurgical  services  that  are  reasonably  necessary  and  related  to  injuries  sustained  by  an \nemployee. Ark. Code Ann. § 11-9-508(a). A claimant must prove, by a preponderance of the \nevidence,  that  medical  treatment  is  reasonable  and  necessary. Wal-Mart  Stores,  Inc.  v. \nBrown, 82 Ark. App. 600, 120 S.W.2d 153 (2003). Reasonable and necessary medical services \nmay include those necessary to, among other things, reduce or alleviate symptoms resulting \nfrom the compensable injury. Jordan v. Tyson Foods, Inc., 51 Ark. App. 100, 911 S.W.2d 953, \n1995 Ark. App. LEXIS 589. \nThe claimant initially sought surgical intervention from Dr. Norton. Despite multiple \nefforts, he was unable to resolve her wrist problems and ultimately referred Ms. Puckett to \nDr. Walker for more treatment options. Dr. Walker assessed CRPS and attempted to improve \nher  symptoms,  but  without  much  success.  Dr.  Walker  recommended  referral  to  UAMS  for \nfurther evaluation and consideration of a Spinal Cord Simulator. \nThe  claimant  seeks  an  Order  from  the  Commission  finding  that  that  referral  is \nreasonable and necessary, as well as the treatments, prescriptions, and referral(s) from her \nPCP, Dr. Scott.  \nThe respondents argue against additional medical treatment. \nIn his continued efforts to resolve Ms. Puckett’s wrist problems, Dr. Norton noted in \nhis 27 April 2021 informed consent discussion [see Cl. Ex. No 1 at 94] that developing \nCRPS/RSD  was  a  risk  associated  with  revision  surgery.  That procedure  was  performed \nwithout  the  desired  result,  and  the  claimant  was  later  assessed  with  CRPS.  I  do  not  find \npersuasive  evidence  that  the  CRPS  and  eventual  referral  for  evaluation  for  a  Spinal  Cord \nStimulator are not related to the initial compensable injury; and I do find, accordingly, that \nthe Dr. Walker’s referral is a reasonable and necessary continuation of the treatment and/or \nmanagement of Ms. Puckett’s wrist problems. \n\nPUCKETT – G808579 \n \n23 \n \nThe claimant has seen and continues to see Dr. Scott for a number of health issues, \nincluding her compensable injury. To the extent that he has or continues to see Ms. Puckett \nfor care related to her wrist, that treatment was and is unauthorized. The respondents are \nnot liable for treatments, prescriptions, and referrals related thereto. \nE.  Attorney’s Fee \nArkansas law generally does not provide for an attorney’s fee to be awarded relating \nto  medical  services.  ACA  §  11-9-715.  While  the  claimant  has  proven  her  burden  as  to  the \nright to additional treatment for her compensable injury, attorney’s fees do not attach to her \nprevailing on that point. She has not proven her burden on the other issues litigated in this \nmatter. \nV.  ORDER \n Consistent with the findings of fact and conclusions of law set forth above, the \nrespondents are responsible for the reasonable and necessary care associated with Dr. \nWalker’s treatment and referral for consideration of additional treatment, including \nevaluation for a Spinal Cord Stimulator. Ms. Puckett’s other claims are denied. \nSO ORDERED. \n \n________________________________ \n       JAYO. HOWE \n       ADMINISTRATIVE LAW JUDGE","preview":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION AWCC FILE No G808579 JURMICKA PUCKETT, EMPLOYEE CLAIMANT AR. DEPT. OF CORRECTIONS, EMPLOYER RESPONDENT PUBLIC EMPLOYEE CLAIMS DIVISION, TPA RESPONDENT OPINION FILED 4 OCTOBER 2023 On hearing before Arkansas Workers’ Compensation Commission (AWCC) Administrative Law J...","fetched_at":"2026-05-19T23:01:15.886Z","links":{"html":"/opinions/alj-G808579-2023-10-04","pdf":"https://labor.arkansas.gov/wp-content/uploads/PUCKETT_JURMICKA_G808579_20231004.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}