{"id":"alj-G906350-2023-03-02","awcc_number":"G906350","decision_date":"2023-03-02","opinion_type":"alj","claimant_name":"Laura Easley","employer_name":"College Hill Middle School","title":"EASLEY VS. COLLEGE HILL MIDDLE SCHOOL. AWCC# G906350 MARCH 2, 2023","outcome":"granted","outcome_keywords":["granted:1"],"injury_keywords":["ankle","neck","thoracic","cervical","back","lumbar","strain","hip"],"pdf_url":"https://labor.arkansas.gov/wp-content/uploads/EASLEY_LAURA_G906350_20230302.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"EASLEY_LAURA_G906350_20230302.pdf","text_length":38370,"full_text":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION \nCLAIM NO. G906350 \n \nLAURA D. EASLEY,   \nEMPLOYEE                                                  CLAIMANT \n \nCOLLEGE HILL MIDDLE SCHOOL,   \nEMPLOYER                                                RESPONDENT \n \nARKANSAS SCHOOL BOARDS ASS’N \nWORKERS’ COMPENSATION TRUST/ \nARKANSAS SCHOOL BOARDS ASS’N,   \nINSURANCE CARRIER/TPA                                                                    RESPONDENT \n \n \nOPINION AND ORDER FILED MARCH 2, 2023 \n \nHearing  before  the  Arkansas  Workers’  Compensation  Commission  (the  Commission)  before \nAdministrative  Law  Judge  (ALJ)  Mike  Pickens  on  December  2,  2022,  in  Texarkana,  Miller \nCounty, Arkansas.   \n \nThe claimant was represented by the Honorable Gregory R. Giles, Moore, Giles & Matteson, LLC, \nTexarkana, Miller County, Arkansas.   \n \nThe  respondents  were  represented  by  the  Honorable  Melissa  Wood,  Worley,  Wood  &  Parrish, \nLittle Rock, Pulaski County, Arkansas. \n \nINTRODUCTION \n     In the Prehearing Order filed September 23, 2022, the parties agreed to the following \nstipulations, which they modified and then affirmed on the hearing record: \n1. The Arkansas Workers’ Compensation Commission (the Commission) has \njurisdiction over this claim. \n2. The  employer/employee/carrier-TPA  relationship  existed  at  all  relevant  times \nincluding  August  13,  2019,  when  the  claimant  sustained  compensable  injuries  to \nher right ankle, neck, and thoracic spine. \n \n3.   The claimant’s average weekly wage (AWW) was $484.92, entitling her to weekly \ncompensation rates of $323.00 for temporary total disability (TTD), and $242.00 \nfor permanent partial disability (PPD) benefits. \n \n\nLaura D. Easley, AWCC No. G906350 \n \n \n \n2 \n4. The respondents have accepted and paid a five percent (5%) permanent anatomical \nimpairment rating for the claimant’s compensable right ankle injury, as well as a \nten   percent   (10%)   to   the   body-as-a-whole   (BAW)   permanent   anatomical \nimpairment rating for her compensable neck injury.   \n \n5.        The respondents do not dispute the fact the claimant fell at home in August of 2020, \nas they paid for additional medical treatment for her right ankle and neck/cervical \nspine following this fall.   \n \n6. The respondents controvert the claimant’s alleged lower back/lumbar spine injury, \nas  well  as  her  request  for  any  additional  medical  treatment  and  additional  TTD \nbenefits other than the medical and TTD benefits they have paid to date. \n \n7. The  parties  specifically  reserve  any  and  all  other  issues  for  future  determination \nand/or hearing. \n \n(Commission Exhibit 1 at 2; Hearing Transcript at 5-7; Respondents’ Post-Hearing Brief at 1).   \n     Pursuant to the parties’ mutual agreement the issues litigated at the hearing were: \n1. Whether,  within  the  meaning of  the  Arkansas  Workers’  Compensation Act  (the \nAct),  the  claimant  sustained  a “compensable  injury”  to  her  lower  back/lumbar \nspine, either as a result of the August 13, 2019, compensable work injury, and/or \nthe admitted compensable consequence incident/fall of August 22, 2020.    \n \n2. Whether the claimant is entitled to additional TTD benefits from August 22, 2020, \nthrough  March  8,  2021;  and  from  July  13,  2022,  through  a  date  yet  to  be \ndetermined. \n \n3. Whether the claimant is entitled to the additional medical treatment Dr. Ardoin has \nrecommended  for  her  compensable  right  ankle  injury,  specifically,  a  right  ankle \nfusion; as well as whether the claimant is entitled to additional medical treatment – \nspecifically  pain  management  treatment –  for  her  cervical  and  thoracic  spine,  as \nwell as the alleged lumbar spine injury. \n        \n4. Whether the claimant’s attorney is entitled to a controverted fee on these facts. \n \n5. The parties specifically reserve any and all other issues for future litigation and/or \ndetermination.    \n\nLaura D. Easley, AWCC No. G906350 \n \n \n \n3 \n \n(Comms’n Ex. 1 at 2-3; T. at 5-12; and Claimant’s Post-Hearing Brief; Respondents’ Post-Hearing \n \nBrief). \n \nFirst, the claimant contends she sustained compensable injuries to her thoracic spine and \nlumbar spine, either immediately as a result of the initial work incident of August 13, 2019, and/or \na compensable consequence event that occurred on August 22, 2020, when she fell at home. The \nclaimant contends the additional medical treatment, specifically the right ankle fusion Dr. Ardoin \nhas  recommend,  is  related  to  and  reasonably  necessary  in  light  of  her  compensable  injury  of \nAugust 13, 2019, and/or the compensable consequence incident of August 22, 2020. She contends \nshe is not at maximum medical improvement (MMI) with regard to her compensable right ankle \ninjury  and,  therefore,  she  is  entitled  to  additional  TTD  benefits  from  August  22,  2020,  through \nMarch 8, 2021; and from July 13, 2022, through a date yet to be determined. Second, the claimant \ncontends  the  medical  treatment  she  has  received  to  date  for  her  right  ankle,  as  well  as  for  her \ncervical,  thoracic,  and  lumbar  spine  injuries  has  been  and  remains  related to  and  reasonably \nnecessary for either the August 13, 2019, work incident and/or the August 22, 2020, compensable \nconsequence  incident  and,  therefore,  the  respondents  should  be  ordered  to  pay  for  this  medical \ntreatment as well as for continuing medical treatment for all these injuries, including all the pain \nmanagement treatment the claimant has received or will receive in the future at Pain Treatment \nCenters of America. Third, the claimant contends the respondents have controverted any and all \nindemnity payments other than those they have already paid to date and, therefore, they should be \nordered to pay a controverted attorney's fee. The claimant specifically reserves any and all other \n\nLaura D. Easley, AWCC No. G906350 \n \n \n \n4 \nissues for future litigation and/or determination. (Comms’n Ex. 1 at 3-4; T. at 8-10; Cl.’s Brief).   \n The respondents contend they have paid all appropriate medical and indemnity benefits to \ndate, and they are continuing to pay all appropriate and necessary medical and indemnity benefits. \nThe  respondents  contend  further  that  Dr.  Martin  performed  an  independent  medical  evaluation \n(IME) and indicated the right ankle fusion surgery Dr. Ardoin has recommended is not reasonably \nnecessary, primarily because of the claimant's high BMI of 49. Therefore, in light of the claimant’s \nhigh BMI, the respondents contend they should not be liable for payment for the recommended \nright ankle fusion surgery. The respondents contend the additional medical treatment the claimant \nis  requesting  for  her  cervical  spine  and  her  thoracic  strain  is  not  related  to  nor  is  it  reasonably \nnecessary  for  treatment  of  her  compensable  injury  of  August  13,  2020,  or  the  compensable \nconsequence incident of August 22, 2020. The respondents contend the claimant did not sustain a \ncompensable  injury within  the  Act’s  meaning  to  her  lower  back/lumbar  spine  at  any  time. \nConcerning the claimant's requested additional/continued pain management treatment for her right \nankle,  cervical,  thoracic,  and  lumbar  spine,  the  respondents  contend  that  additional  medical \ntreatment is not related to nor is it reasonably necessary in light of any of her injuries, compensable \nor otherwise. The respondents contend the medical records do not support the claimant’s request \nfor additional TTD benefits. They contend the claimant has been assigned a 10% BAW impairment \nrating for her cervical injury, which they have accepted and paid in full; and that Dr. Martin has \nassigned  her  a  20%  BAW  impairment  rating  for  her  right  ankle  injury,  and  that the  parties  are \nworking together to clarify this rating. The respondents specifically reserve any and all other issues \nfor future litigation and/or determination. (Comms’n Ex. 1 at 4-5; T. at 10-11; Resps’. Brief). \n\nLaura D. Easley, AWCC No. G906350 \n \n \n \n5 \n     The record consists of the hearing transcript and any and all exhibits contained therein and \nattached thereto, as well as the parties’ blue-backed post-hearing briefs. \nSTATEMENT OF THE CASE \n       The claimant, Ms. Laura D. Easley (the claimant), is 52 years old. It is undisputed she fell \nat work on August 13, 2019, and sustained injuries to her right ankle, as well as to her cervical and \nthoracic spine. The respondents accepted these injuries as compensable and paid both medical and \nindemnity benefits, including surgery on the claimant’s right ankle and cervical spine.  It is also \nundisputed the claimant fell at her home on August 22, 2020, when her right ankle gave-out as she \nwas   walking.   The   respondents   paid   for   additional   medical   treatment   for   the   claimant’s \nneck/cervical spine, and right ankle following this incident. The claimant contends she injured her \nlower  back/lumbar  spine  at  this  time;  however,  in  light  of  the  claimant’s  past  history  of \nsymptomatic  lower  back/lumbar  spine  problems  the  respondents  controverted the  claimant’s \nalleged lower back/lumbar spine injury.     \n     Consequently,  the  issues  litigated  at  the  subject  hearing  and  to  be  decided  herein  are:  (1) \nwhether the claimant sustained a “compensable injury” to her lower back/lumbar spine within the \nAct’s meaning either in the initial fall at work on August 13, 2019, or as a result of the fall at her \nhome on August 22, 2020; (2) whether the right ankle fusion surgery Dr. Ardoin has recommended \nfor  the  claimant  is  related  to  and  constitutes  reasonably  necessary  medical  treatment  for  her \nadmittedly compensable right ankle injury; and, (3) whether the claimant is entitled to additional \npain management treatment for her cervical and thoracic spine and – if the alleged injury is deemed \n“compensable”  –  for  her  alleged  lower  back/lumbar  spine  injury.  Rather  than  recite  a  detailed \n\nLaura D. Easley, AWCC No. G906350 \n \n \n \n6 \nstatement and analysis of the relevant medical and other evidence here, I will do so below in the \n“Discussion” portion of this opinion and order.                 \nDISCUSSION \nBurden of Proof \nWhen deciding any issue, the ALJ and the Commission shall determine, on the basis of the \nrecord as a whole, whether the party having the burden of proof on the issue has established it by \na  preponderance  of  the  evidence. Ark.  Code  Ann. §  11-9-704(c)(2)  (2022  Lexis  Replacement). \nThe  claimant  has  the  burden  of  proving  by  a  preponderance  of  the  evidence  he  is  entitled  to \nbenefits. Stone  v.  Patel, 26  Ark.  App.  54,  759  S.W.2d  579  (Ark.  App.  1998). Ark.  Code  Ann. \nSection 11-9-704(c)(3) (2022 Lexis Repl.) requires the ALJ, the Commission, and the courts “shall \nstrictly construe” the Act, which also requires them to read and construe the Act in its entirety, and \nto harmonize its provisions when necessary. Farmers Coop. v. Biles, 77 Ark. App. 1, 69 S.W.2d \n899  (Ark.  App.  2002).  In  determining  whether  the  claimant  has  met  his  burden  of  proof,  the \nCommission is required to weigh the evidence impartially without giving the benefit of the doubt \nto either party. Ark. Code Ann. § 11-9-704(c)(4) (2022 Lexis Repl.); Gencorp Polymer Products \nv. Landers, 36 Ark. App. 190, 820 S.W.2d 475 (Ark. App. 1991); Fowler v. McHenry, 22 Ark. \nApp. 196, 737 S.W.2d 633 (Ark. App. 1987).   \nAll claims for workers’ compensation benefits must be based on proof. Speculation and \nconjecture, even if plausible, cannot take the place of proof. Ark. Dep’t of Corrections v. Glover, \n35 Ark. App. 32, 812 S.W.2d 692 (Ark. App. 1991); Deana Constr. Co. v. Herndon, 264 Ark. 791, \n\nLaura D. Easley, AWCC No. G906350 \n \n \n \n7 \n595 S.W.2d 155 (1979). It is the Commission’s exclusive responsibility to determine the credibility \nof the witnesses and the weight to give their testimony. Whaley v. Hardees, 51 Ark. App. 116, 912 \nS.W.2d 14 (Ark. App. 1995). The Commission is not required to believe either a claimant’s or any \nother witness’s testimony, but may accept and translate into findings of fact those portions of the \ntestimony it deems believable. McClain v. Texaco, Inc., 29 Ark. App. 218, 780 S.W.2d 34 (Ark. \nApp. 1989); Farmers Coop. v. Biles, supra.   \nThe  Commission  has  the  duty  to  weigh  the  medical  evidence  just  as  it  does  any  other \nevidence,  and  its  resolution  of  the  medical  evidence  has  the  force  and  effect  of  a  jury  verdict. \nWilliams v. Pro Staff Temps., 336 Ark. 510, 988 S.W.2d 1 (1999). It is within the Commission’s \nprovince  to  weigh  the  totality  of  the  medical  evidence  and  to  determine  what  evidence  is  most \ncredible  given  the  totality  of  the  credible  evidence  of  record. Minnesota  Mining  &  Mfg’ing  v. \nBaker, 337 Ark. 94, 989 S.W.2d 151 (1999). \nCompensability of the Claimant’s Lower Back/Lumbar Spine Condition \n     For   any   specific-incident   injury   to   be   compensable,   the   claimant   must   prove   by   a \npreponderance of the evidence that her injury: (1) arose out of and in course of her employment; \n(2) caused internal or external harm to his body that required medical services; (3) is supported   \nby objective findings, medical evidence, establishing the alleged injury; and (4) was caused by a \nspecific  incident  identifiable  by  time  and  place  of  occurrence. Ark.  Code  Ann.  §  11-9-102(4); \nCossey v. Gary A. Thomas Racing Stable, 2009 Ark. App. 666, at 5, 344 S.W.3d 684, 687 (Ark. \nApp.  2009).  Of  course,  the  claimant  bears  the  burden  of  proving  the  compensable  injury  by  a \npreponderance of the credible evidence. Ark. Code Ann. § 11-9-102(4)(E)(i); and Cossey, supra.   \n\nLaura D. Easley, AWCC No. G906350 \n \n \n \n8 \n       “Objective findings” are those findings which cannot come under the voluntary control of \nthe patient. Ark. Code Ann. § 11-9-102(16)(A); Long v. Wal-Mart Stores, Inc., 98 Ark. App. 70, \nat  80  250  S.W.3d  263,  at  272  (Ark.  App.  2007).  Objective  findings, “specifically  exclude  such \nsubjective complaints or findings such pain, straight-leg-raising tests, and range-of-motion tests.” \nBurks  v.  RIC,  Inc.,  2010  Ark.  App.  862  (Ark.  App.  2010).  Objective  medical  evidence  is  not \nessential to establish a causal relationship between the work-related accident and the alleged injury \nwhere objective medical evidence exists to prove the existence and extent of the underlying injury, \nand a preponderance of other nonmedical evidence establishes a causal relationship between the \nobjective  injury  and  the  work-related  incident(s)  in  question. Flynn  v.  Southwest  Catering  Co., \n2010  Ark.  App.  766,  379  S.W.3d  670  (Ark.  App.  2010).  Moreover,  the  claimant  must  prove  a \ncausal relationship exists between her employment and the alleged injury. Wal-Mart Stores, Inc., \nv. Westbrook, 77 Ark. App. 167, 171, 72 S.W.3d 889, 892 (Ark. App. 2002) (citing McMillan v. \nU.S. Motors, 59 Ark. App. 85, 90, 953 S.W.2d 907, 909 (Ark. App. 1997)).   \n     Concerning the proof required to demonstrate the aggravation of a preexisting condition, our \nappellate courts have consistently held that since an aggravation is a new injury, a claimant must \nprove it by new objective evidence of a new injury different than the preexisting condition. Vaughn \nv. Midland School Dist., 2012 Ark. App. 344 (Ark. App. 2012) (citing Barber v. Pork Grp., Inc., \n2012 Ark. App. 138 (Ark. App. 2012); Grothaus v. Vista Health, LLC, 2011 Ark. App. 130, 382 \nS.W.3d 1 (Ark. App. 2011); Mooney v. AT & T, 2010 Ark. App. 600, 378 S.W.3d 162 (Ark. App. \n2010)  (Emphases  added.).  Where  the  only  objective  findings  present  are  consistent  with  prior \nobjective  findings or  consistent  with  a  long-term  degenerative  condition  rather  than  an  acute \n\nLaura D. Easley, AWCC No. G906350 \n \n \n \n9 \ninjury, this does not satisfy the objective findings requirement for the compensable aggravation of \na preexisting condition injury. Vaughn, 2012 Ark. App. 344, at 6 (holding that Arkansas courts \nhave interpreted the Act to require “new objective medical findings to establish a new injury when \nthe  claimant  seeks  benefits  for the  aggravation  of  a  preexisting  condition”); Barber,  supra \n(affirming the Commission’s denial of an aggravation of a preexisting condition claim where the \nMRI  findings  revealed  a  degenerative  condition,  with  no  evidence  of,  and  which  could  not  be \nexplained  by,  an  acute  injury)  (Emphases  added.).  In Mooney,  2010  Ark.  App.  600  at  4-6,  378 \nS.W.3d at 165-66 (Ark. App. 2010), the court affirmed the Commission’s decision denying a back \ninjury claim where the objective evidence of an injury - including muscle spasms, positive EMG \ntest results, and spinal stenosis revealed on an MRI  - were  all present both before and after the \ndate of the alleged aggravation injury. (Emphasis added). \n       Based  on  the  aforementioned  law  as  applied  to  the  facts  of  this  case,  the  totality  of  the \ncredible  evidence  of  record –  particularly  the  medical  evidence –  I  am  compelled  to  find  the \nclaimant has failed to meet her burden of proof in demonstrating she sustained a lower back/lumbar \nspine injury as a result of either of the two (2) incidents in question – the August 13, 2019, fall at \nwork, or the August 22, 2020 fall at home. \n         The  claimant  has  a  long-standing,  well-documented  history of symptomatic,  “severe” \nlower back/lumbar spine pain/complaints. There exists no objective medical evidence proving \nshe  sustained  a  “compensable  injury”  within  the  Act’s  meaning  as  a  result  of  either  of  the \naforementioned falls. MRIs of her lower back/lumbar spine taken both before and after the two \n(2)  falls  in  question  are  essentially  the  same,  and  reflect  only  congenital  spondylosis  other \n\nLaura D. Easley, AWCC No. G906350 \n \n \n \n10 \nevidence of degenerative disc disease (DDD). Indeed, the claimant’s medical records reflect she \nhas suffered from preexisting and “severe” lower back pain, as well as pain and numbness that \nradiated  into  both  her  legs.  The  claimant  also  admitted  under  oath  she  had  issues  with \nincontinence  starting  in  approximately  2017.  (T.  110).  The  record  does  not  reflect  objective \nfindings of an acute lower back/lumbar spine injury associated with either of the falls involved \nin  this  case;  rather  it  reflects  the  claimant  has  a  documented  history  of  symptomatic  lower \nback/lumbar spine problems. \n       A clinic note dated February 14, 2017, reveals at that time the claimant complained of \nconstant lower back pain  with a severity of 8/10.  (Claimant’s Exhibit 1 at 4). Furthermore, it \nappears one of the claimant’s treating physicians had already discussed the possibility of surgery \nwith  her  back  in  2017,  and  told  her  she  was  too  young  to  have  back  surgery  in  her  30s.  The \nmedical record reveals the claimant was complaining of “severe” lower back pain at this visit, \nas well as numbness and tingling in her buttocks and both legs. (Id.)     \nOn July 2, 2019 – approximately one (1) month before her fall at work on August 13\nth\n, \n2019 – the claimant presented herself for treatment at HealthCare Express complaining of lower \nback pain with muscle spasms. (T. 109). She testified under oath she recalled going to her doctor \naround  this  timeframe  because  her  back  was, “pinching up again,” and  her  doctor  prescribed \nsome muscle relaxers and physical therapy (PT) at that time. (T. 106). On February 1, 2021, the \nclaimant underwent an MRI based on her complants of, “low back pain, bilateral leg pain and \nbladder control issues.” (CX2 at 286). This MRI revealed multilevel lumbar spondylosis most \npronounced at L4-5 and L5-S1. (CX2 at 287). And, again, the claimant admitted under oath she \nhas a prior history of low back pain/lumbar spine problems. (T. 24; and 49-50).   \n\nLaura D. Easley, AWCC No. G906350 \n \n \n \n11 \n          The HealthCare Express records reveal the claimant suffered from acute lower back \npain  on  July  2,  2019  with  muscle  spasms  and  again  on  July  17,  2019  (CX2  at  86-87;  90-93) \nbefore the work-related fall of August 13, 2019. These records further reveal the claimant was \neven treated for some upper back pain identified as thoracic spine pain and radiculitis of her left \ncervical region on August 9, 2019 some four (4) days before the work-related fall of August 13, \n2019. (CX2 at 94-95). \n   On January 18, 2021 – after the claimant’s August 22, 2020, fall at home when her right \nankle gave-way – Dr. Wayne Bruffett reviewed the claimant’s MRI of December 28, 2020.    Dr. \nBruffett explained  the  claimant’s  MRI  revealed,  “disc  degeneration  with  some  endplate  modic \nchanges...degenerative disc disease, lumbar spine.” (CX2 at 267; 268-270). Dr. Bruffett went on \nto state, “this does not look like a work-related problem.” (CX2  at  268-270).  As  a  result  of  her \ncontinuing  lower  back/lumbar  spine  complaints  the  claimant  underwent  another  MRI  of  her \nlumbar spine on February 1, 2021 (CX2 at 286-287). This MRI revealed the, “possibility of T9-10 \ndisc protrusion with posterior element hypertrophy at T10-11\", as well as, “moderate degenerative \nchanges most pronounced at L4-5 and L5-S1 previously identified in the MRI of December 28, \n2020.” (CX2 at 286-287; 267). \n Thereafter, on May 26, 2021, Dr. Bruffett once again examined the claimant, at which time \nDr.  Bruffett  agreed  a  second  MRI  was  necessary to  assist  him  in  assessing  her  thoracic  spine \nissue/complaints.  (CX2  at  364-367).  With  regard  to  the claimant’s lumbar  spine  Dr.  Bruffett \nclearly  stated he  could,  “not  say  within  a  reasonable  degree  of  medical  certainty  that there  is \nobjective  evidence  of  injury  here  related  to  her  fall  which  would  tie  this  into  her  work  injury.” \n\nLaura D. Easley, AWCC No. G906350 \n \n \n \n12 \n(CX2 at 364-367). \n On June 16, 2021, the claimant underwent a second thoracic spine MRI. This MRI revealed \na, “small left paracentral disc protrusion at T6-7\", a, “mild disc bulge at T7-8\", a, “small central \ndisc protrusion at T9-10\", a, “bulging disc at T10-11\" and, “moderate to marked foraminal stenosis \nat T6-7 on the left and laterally at T7-8, T9-10, T10-11\". In summary, this MRI revealed, “diffuse \nspondylosis as described. There is small left paracentral disc protrusion at T6-7 and extending into \nthe left neural foramen. Mild disc bulge seen at T7-8. Small central disc protrusion is seen at T9-\n10.    Bulging disc is seen at T10-11.    There is mild spinal stenosis at T10-11. Moderate to marked \nforaminal stenosis is seen at T6-7 on the left and bilaterally at T7-8, T9-10, T10-11... .” (CX2 at \n379). \n Dr. Bruffett opined, “in part she multiple disc degeneration, she has facet arthritis, there \nare levels of disc bulging and foraminal narrowing.    I would say within a reasonable degree of \nmedical certainty that these findings are greater than 51% related to degenerative natural causes as \nopposed to any specific work injury...I have told her I cannot identify any objective evidence of \ninjury to her back.”...“welcome to have further treatments for her back under regular insurance \nwith pain management specialist for further treatment.” (CX2 at 380-382). \n After Dr. Bruffett’s aforementioned evaluation and opinion, the claimant sought a second \nopinion from Dr. Glenn Pait at the Neurosurgery Clinic at the University of Arkansas for Medical \nSciences (UAMS). After both personally examining the claimant, and reviewing both her lumbar \nand  thoracic  spine  MRI  films  Dr.  Pait concluded  in  part,  “I  would  not  recommend  surgical \nintervention for the thoracic discogenic or lumbar degenerative changes.    The discogenic changes \n\nLaura D. Easley, AWCC No. G906350 \n \n \n \n13 \nare  of  chronic  nature.”    He  instead  recommended,  “continued  consultation  and  support  with \ninterventional/chronic pain center... .” (CX2  at 433A-433C). Following both Dr. Bruffett’s and \nDr. Pait’s evaluations the claimant has remained under the care of the Pain Treatment Centers of \nAmerica,  and  undergone  additional  MRIs  and  other  diagnostic  tests  of  both  her  lumbar  and \nthoracic spine that reveal evidence of long-standing DDD. (CX2 at 443-444; 462A-462B; CX2 at \n465). Therefore,  based  on  the  claimant’s  aforementioned  well-documented  history  of  “severe” \nlower   back/lumbar   spine   pain   with   bilateral   radiculopathy,   which   includes   a   history   of \nincontinence even before either of the subject falls, it is clear the claimant has failed to meet her \nburden  of  proof  pursuant  to  the  Act  in  demonstrating  her  lower  back/lumbar  spine  condition  is \ncompensable. See, Vaughn and Moody, supra.     \nRelated, Reasonably Necessary Medical Care \nArk. Code Ann. Section 11–9–508(a) (2022 Lexis Supp.) requires  employers to provide \nmedical  services  that  are  reasonably  necessary  in  connection  with  a  compensable  injury.  A \nclaimant may be entitled to additional medical treatment after her healing period has ended if it is \ngeared toward management of symptoms associated with her compensable injury(ies). Santillan \nv. Tyson Sales & Distribution, 2011 Ark. App. 634, 386 S.W.3d 566 (Ark. App. 2011); Cossey v. \nPepsi Beverage Co., 2015 Ark. App. 265, 3, 460 S.W.3d 814, 817 (Ark. App. 2015). Of course, \nsignificantly,  in  addition  to  being  reasonably  necessary  for  treatment  of  her  compensable \ninjury(ies), the requested additional medical treatment must be causally related to the compensable \ninjury(ies).     \nIn this case, with regard to the claimant’s thoracic lower back/lumbar spine, the claimant \n\nLaura D. Easley, AWCC No. G906350 \n \n \n \n14 \nhas failed to meet her burden of proof in demonstrating she has sustained a “compensable injury” \nto  her  lower  back/lumbar  spine.  Therefore,  the  respondents  are  not  responsible  for  any  and  all \nmedical  treatment  related to  the  claimant’s  lower  back/lumbar  spine.  Dr.  Bruffett  opined  the \nclaimant  reached  MMI  on  May  15,  2021,  and  he  clearly  stated  she  did  not  need  any  further \ntreatment after this date based on her thoracic strain. (Respondents’ Exhibit 1 at 19-20). He later \nclarified that while she probably had a thoracic strain, “none of the findings noted on her thoracic \nMRI scan from June 16, 2021, can be attributed to these complaints with any reasonable degree of \nmedical  certainty  in  my  opinion...[the  findings  are]  much  more  likely  pre-existing”  and  age-\nrelated. (RX1 at 22) (Bracketed material added). I specifically find Dr. Bruffett’s opinion to be the \nmost objective and credible opinion concerning this issue, as well as the most consistent with the \nrelevant medical evidence. \nWith  regard  to  the  right  ankle  fusion  surgery  Dr.  Ardoin  has  recommended,  the \nrespondents’  position  is  that  this  proposed  additional  medical  treatment  did  not  meet pre-\ncertification and, therefore, is not reasonably necessary for the following reasons: \nThere  is  no  documentation  of  limited  range  of  motion  or  crepitus.    MRI \ndoes  not  document  arthritis.    Her  x-ray  documented  a  stable  medial  talar \nosteochondral  lesion  but  no  other  arthritic  pathology  documented  by  Dr. \nArdoin. \n \n(RX1 at 35).   \n The  respondents  also  note  that  Dr.  Robert  Martin  performed  an  IME  regarding  the \nclaimant’s right ankle on June 13, 2022, and Dr. Martin opined the claimant was at MMI as of the \ndate of his IME, and that the claimant, “would likely not experience significant relief from an ankle \narthrodesis and she is not a candidate for ankle arthroplasty based on her BMI of 49.” (RX1 at 25-\n\nLaura D. Easley, AWCC No. G906350 \n \n \n \n15 \n28).   \n       However,  I  specifically  find  that  Dr.  Ardoin,  the  claimant’s  treating  surgeon  who  has \nalready operated on her  right ankle, is in the best position to assess her need for the right ankle \nsurgery.  Also,  having  initially  accepted  the  claimant’s  right  ankle  injury  as  compensable  and \npaying for all related, reasonably necessary medical treatment to date; and having acknowledged \nthe fact the claimant re-injured her right ankle – or at the very least fell at home as a result of her \nright ankle giving-way on August 22, 2020 – the respondents are not now in a credible position to \ndeny the claimant’s request for the additional surgery her treating surgeon recommends, and which \nmay very well give the claimant more mobility and a better quality of life. \n       Moreover, with respect to the claimant’s acknowledged/admitted compensable right ankle \ninjury, it should be noted that it took the respondents some time before they were willing to accept \nand acknowledge the compensable consequence event of August 22, 2020. This delay necessitated \nthe claimant’s having to seek additional medical treatment for the compensable right ankle injury \non  her  own  using  her  personal  health  insurance.  And  it  appears  from  the  preponderance  of  the \nevidence of record that the nature of the claimant’s symptoms rendered her unable to perform her \njob duties, and the respondents were unable to provide a light duty or other related job to her which \naccommodated  her  symptoms  and  resulting  temporary  disability,  symptoms,  the  claimant  was \nforced by the prevailing circumstances to submit a letter of resignation. (T. 47-48).     \n      Indeed, all the aforementioned circumstances resulted in it taking some seven (7) months for \nthe claimant to finally undergo an updated MRI of her right ankle, and for Dr. Ardoin to review \nthe  MRI  results,  and  recommend  the  right  ankle  fusion  surgery.  The  respondents  accepted  the \n\nLaura D. Easley, AWCC No. G906350 \n \n \n \n16 \nclaimant’s request for additional TTD benefits and began paying her as of March 9, 2021. They   \ncontinued to pay TTD benefits through July 12, 2022, and the claimant was deemed to be at MMI \nas of June 14, 2022 based upon Dr. Martin’s IME assessment. (CX2 at 447-450).   \n It should be noted the claimant’s right ankle injury is scheduled and she is entitled to TTD \nbenefits during the period of time when she remained within a healing period and was not working. \nArk.  Code  Ann.  §11-9-521(a). See, Wheeler  Corp.  Co.  vs.  Armstrong,  73  Ark.  App  146,  41 \nS.W.3rd 824 (Ark. App. 2001). See also, Fendley vs. Pea Ridge School District, 97 Ark. App. 214, \n245 S.W.3rd 676, 2006 Ark. App. LEXIS 846. \n Dr.  Ardoin,  the claimant’s treating  physician  who  performed  her  first  two  (2)  surgeries, \nclearly has tried various available treatment modalities to try and improve the stability or her right \nankle, as well as her pain. His progress notes confirm following the second surgery that he put her \nin a boot and recommended, “eight weeks of aggressive range of motion therapy”. (CX2 at 371-\n373).  Despite  Dr.  Ardoin’s  aggressive  PT,  the  therapist  noted  in  December  of  2021  that  the \nclaimant was continuing to complain of swelling and pain. And, despite the claimant’s undergoing \nice machine therapy, the therapist noted only, “minimal improvement and functional mobility and \nnoted, “minimal improvement in strength to her right hip, knee and ankle, and that she remained \nlimited secondary to pain. He noted, “she had met 0/6 of the goals established and that she was \nexperiencing,  pain  with  all  activity  and  is  limited  in  progression  of  strengthening  and  range  of \nmotion.” (CX2 at 427-429).     \n Dr. Ardoin ordered additional testing including a bone scan and MRI (CX2 at 434).    The \nbone scan noted, “increased uptake on blood pool and delayed images at the distal end of the fibula \n\nLaura D. Easley, AWCC No. G906350 \n \n \n \n17 \nand in the region of the anterior aspect of distal end of the tibia” and the differential diagnosis was, \n“trauma and arthritis”. (CX2 at 437a-437b).     \n Although the MRI did not identify a complete tear, it found, “irregularity of the peroneus \nbrevis  tendon medially inferior to  the level  of the lateral  malleous” and noted it was  “unclear” \nwhether  those  changes  were,  “postop  vs  tear”.  Also  noted,  “unstable  appearing  osteochondral \nlesion within the medial talar dome... .” (CX2 at 438)   \n Upon continuing examination, Dr. Ardoin noted the claimant to have, “continued redness \nand swelling of the ankle” (CX2  at  441).  Although  he  apparently  described  her  tendons  at  that \npoint  as  looking  like,  “garbage”,  he  recommended  trying  a, “custom  Arizona  brace”  before \nconsidering fusion surgery as the last resort. (CX2 at 441-442). \n Dr. Ardoin had the opportunity to review the opinions of Dr. Martin, who had opined the \nproposed right ankle fusion surgery was not reasonable necessary. Dr. Ardoin disagreed with Dr. \nMartin’s opinion in this regard, and I find Dr. Ardoin’s opinion should be given more weight on \nthese  facts.  Dr.  Ardoin  expressed  his  disagreement  in  his  progress  note  of  June  27,  2022.    He \nstated in part,   \nI reviewed the independent medical evaluation from Dr. Martin, however, I do feel \nthat  the  patient  would  benefits  from  a  subtalar  joint  arthrodesis  as  a  salvage \nprocedure since she cannot really wear her brace without significant pain from the \npressure applied to the scar.    I think the subtalar joint arthrodesis would allow her \nto not depend on the peroneal tendons which are chronically painful and it would \nbe a procedure that would likely stop her pain, however, she needs to lose weight \nand hopefully by allowing her to be pain free, this may help her in the long run in \nregards to her total body functions...I do think that this is greater than 51% related \nto the work injury she sustained.  I expect MMI to be 9 months post-op...Patient is \ndisabled and does not work... .   \n \n(CX2 at 452-455).     \n\nLaura D. Easley, AWCC No. G906350 \n \n \n \n18 \n     I find the claimant to be a credible and sincere witness. At the hearing she testified she would \nprefer not be left in her current state of very limited mobility and reliance upon the chair-walker \nshe used to attend the hearing. (T. 97-98). While the claimant understands there is no guarantee \nthe proposed right ankle fusion will totally relieve her pain, I find that, based on the specific facts \nof this case, the procedure is reasonably necessary taking into consideration the fact that she’s been \nsuffering since the initial accident of 2019 and would like the opportunity to regain her mobility \nand functionality. (T. 98-99). \nTherefore, for all the aforementioned reasons I hereby make the following: \nFINDINGS OF FACT AND CONCLUSIONS OF LAW \n1. The Commission has jurisdiction over this claim.   \n2. The  stipulations  contained  in  the  Prehearing  Order  Filed  September  23,  2022, \nwhich the parties modified and affirmed on the record at the hearing, hereby are \naccepted as facts.   \n \n3. The  claimant  has  failed  to  meet  her  burden  of  proof  in  demonstrating  she \nsustained a lower back/lumbar spine injury as a result of either of the August 13, \n2019,  or  the  August  22,  2020,  falls.  Therefore,  the  respondents  are  not \nresponsible for payment of any medical or indemnity benefits associated with the \nclaimant’s  long-standing,  well-documented,  symptomatic  lower  back/lumbar \nspine degenerative disc disease/condition. See Vaughn and Moody, supra.     \n \n4. The claimant has met her burden of proof in demonstrating the right ankle fusion \nsurgery Dr. Ardoin has recommended is related to and reasonably necessary in \nlight of her compensable injury. \n \n \n5. The  claimant  has  failed  to  meet  her  burden  of  proof  in  demonstrating  she  is \nentitled  to  additional  medical  treatment  at  the  respondents’  expense  for  her \nthoracic spine strain after May 15, 2021, the date Dr. Bruffett opined she reached \nMMI,  except  for  the  June  16,  2021,  MRI  Dr.  Bruffett  ordered  and  required  in \norder to clarify his opinion.       \n \n\nLaura D. Easley, AWCC No. G906350 \n \n \n \n19 \n6. The claimant has met her burden of proof in demonstrating the pain management \ntreatment she has undergone for her right ankle and neck/cervical spine injuries \nis   related   to   and   reasonably   necessary   for   treatment   of   her   admittedly \ncompensable injuries of August 13, 2019, and August 22, 2020.   \n \n7. The  claimant  has  met  her  burden  of  proof  in  demonstrating  she  is  entitled  to \nadditional TTD benefits from August 22, 2020, through March 8, 2021; and from \nMarch  9,  2021,  through  June  14,  2022,  the  date  Dr.  Martin  opined  she  had \nreached MMI. Of course, the respondents are entitled to take a credit toward this \naward of additional TTD benefits based on any and all indemnity benefits they \nmay have overpaid.   \n \n8. The  claimant’s  attorney  is  entitled  to  an  attorney’s  fee  on  all  controverted \nindemnity payments. \n \n \n                         AWARD \n \n     The respondents are hereby directed to pay benefits in accordance with the “Findings of \nFact and Conclusions of Law” set forth above. All accrued sums shall be paid in lump sum \nwithout discount, and this award shall earn interest at the legal rate until paid pursuant to Ark. \nCode Ann. Section 11-9-809, and Couch v. First State Bank of Newport, 49 Ark. App. 102, 898 \nS.W.2d 57 (Ark. App. 1995); Burlington Indus., et al v. Pickett, 64 Ark. App. 67, 983 S.W.2d \n126 (Ark. App. 1998); and Hartford Fire Ins. Co. v. Sauer, 358 Ark. 89, 186 S.W.3d 229 (2004).   \n     If they have not already done so, the respondents shall pay the court reporter’s invoice \nwithin ten (10) days of their receipt of this opinion and order. \nIT IS SO ORDERED.   \n \n                                              \n \nMike Pickens \nAdministrative Law Judge \n \nMP/mp \n\nLaura D. Easley, AWCC No. G906350 \n \n \n \n20","preview":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION CLAIM NO. G906350 LAURA D. EASLEY, EMPLOYEE CLAIMANT COLLEGE HILL MIDDLE SCHOOL, EMPLOYER RESPONDENT ARKANSAS SCHOOL BOARDS ASS’N WORKERS’ COMPENSATION TRUST/ ARKANSAS SCHOOL BOARDS ASS’N, INSURANCE CARRIER/TPA RESPONDENT OPINION AND ORDER FILED MARCH 2, 2023 Hearing...","fetched_at":"2026-05-19T23:09:04.604Z","links":{"html":"/opinions/alj-G906350-2023-03-02","pdf":"https://labor.arkansas.gov/wp-content/uploads/EASLEY_LAURA_G906350_20230302.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}