{"id":"alj-H100964-2024-11-12","awcc_number":"H100964","decision_date":"2024-11-12","opinion_type":"alj","claimant_name":"Justin Mitchell","employer_name":"Parker Audi","title":"MITCHELL VS. PARKER AUDI AWCC# H100964 November 13, 2024","outcome":"unknown","outcome_keywords":[],"injury_keywords":["shoulder","back","rotator cuff"],"pdf_url":"https://www.labor.arkansas.gov/wp-content/uploads/MITCHELL_JUSTIN_H100964_20241112.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"MITCHELL_JUSTIN_H100964_20241112.pdf","text_length":47164,"full_text":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION \nCLAIM NO.: H100964 \n \nJUSTIN P. MITCHELL, EMPLOYEE CLAIMANT \n \nPARKER AUDI, EMPLOYER  RESPONDENT \n \nCENTRAL ARKANSAS AUTO DEALERS, SIF,  \nCARRIER                                                                                                                RESPONDENT \n                                                     \nRISK MANAGEMENT RESOURCES,        \nTHIRD PARTY ADMINISTRATOR                                                          RESPONDENT  \n  \n \nOPINION FILED NOVEMBER 12, 2024 \n \nA hearing was held before ADMINISTRATIVE LAW JUDGE CHANDRA L. BLACK, in Pulaski \nCounty, Little Rocks, Arkansas. \n \nClaimant represented by the Honorable Laura Beth York, Attorney at Law, Little Rock, Arkansas.    \n \nRespondents represented  by  the  Honorable Melissa  Wood, Attorney at  Law,  Little  Rock, \nArkansas. \n \nSTATEMENT OF THE CASE \n \n A  hearing  was  held  in  the  above-styled  claim  on August 14,  2024, in Pulaski County, \nArkansas.   Following  a  Prehearing  Telephone  Conference with  the  parties on  June 12,  2024,  a \nPrehearing Order was entered in this case on that same day.  \nStipulations \nThe parties  submitted  the following jointly  proposed stipulations either  pursuant to  the \nPrehearing Order, or at the start and/or during the hearing.  I hereby accept the following proposed \nstipulations as fact:  \n 1.  The Arkansas Workers’ Compensation Commission has jurisdiction of the within claim. \n\nMitchell- H100964 \n \n2 \n 2.    The  employee-employer-carrier  relationship  existed on  January  14,  2021,  when  the \nClaimant sustained a compensable injury to his right shoulder while in the course and scope of his \nemployment with the respondent-employer, Parker Audi.  \n 3.  The Claimant was released at maximum medical improvement/MMI by Dr. Lawerance \nO’Malley on October 2, 2023. \n4.  The Claimant was earning sufficient wages ($1,193.27) to entitle him to the maximum \ncompensation rates for a 2021 injury.  These weekly benefit amounts are $736.00 for temporary \ntotal disability (TTD) benefits, and $552.00 for permanent partial disability (PPD) benefits.  \n5.  All issues not litigated herein are reserved under the Arkansas Workers’ Compensation  \n \nAct.  \n \nIssue \n \nBy  agreement  of  the  parties,  the sole issue  to  be  litigated  at  the  hearing  was: Whether \nClaimant is entitled to additional medical treatment, in the form of a peripheral nerve stimulator \nper the recommendation of his treating physician, Dr. Johnathan Goree.  \nContentions \n Claimant: \n On January 14, 2021, the Claimant sustained a compensable right shoulder injury within \nthe course and scope of his employment while pulling on a tire iron.  The Respondents accepted  \nthe injury as compensable and began paying for medical treatment. \n An MRI revealed a torn labrum.  On March 2, 2021, the Claimant underwent surgical repair \nwith Dr. Kirk Reynolds.  Still in pain, Claimant underwent a repeat MRI on September 14, 2021, \nwhich revealed a posterior labral tear from 7- 11 o’clock.  It was noted that this was a large sub-\n\nMitchell- H100964 \n \n3 \nlabral recess or tear of the superior labrum.  On November 16, 2021, Dr. Reynolds performed a \nright  shoulder  arthroscopy.    The  Claimant  underwent  injections with  Dr.  Vargas  due  to  his \ncontinued complaints. \n On  March  15,  2023,  the  Claimant  underwent  an  MRI  which  revealed  a  large  posterior \nlabral tear with labral chondral defect, mild to moderate osteoarthritis grade 2/4 cartilage loss, and \nsupraspinatus muscle atrophy.  The Claimant’s treatment was then switched to Dr. O’Malley, who \nrecommended another shoulder surgery, and Dr. Goree, for his pain management.  On April 27, \n2023, the Claimant underwent a right shoulder scope with posterior labral repair. \n Dr. O’Malley placed the Claimant at MMI on October 2, 2023,  and assessed a 10% whole \nbody impairment rating.  Dr. O’Malley also referred the Claimant for continued treatment with Dr. \nGoree. \n Claimant followed up with Dr. Goree, who noted that the Claimant suffers from Complex \nRegional Pain Syndrome (CRPS) and recommended a peripheral nerve stimulator for his injury.  \nRespondents have denied the stimulator. \n The  Claimant  contends  that  he  is  entitled  to  the  additional  medical  treatment  as \nrecommended by Dr. Goree. \n All other issues are reserved.    \nRespondents: \n \nThe Respondents contend that all appropriate benefits are being paid with regard to this \n \nmatter.  It is Respondents’ position that the peripheral nerve stimulator recommended by Dr. Goree \nis not reasonable and necessary for the Claimant’s compensable injury. \n \n\nMitchell- H100964 \n \n4 \nSummary of Evidence \nMr. Justin Paul Mitchell (referred to herein as the “Claimant”), was the only witness to \ntestify during the hearing.  \nThe record  consists  of  the  hearing  transcript  of  August  14,  2024,  and  the  documents \ncontained therein.  Specifically, Commission’s Exhibit 1 includes the Commission’s Prehearing \nOrder filed  on  June  12,  2024  and  the  parties’  responsive  filings;  Claimant  Medical  Exhibit \nconsisting of one hundred forty one (141) numbered pages was marked as Claimant’s Exhibit 1; \nand Respondents’ Medical Exhibit consisting of three (3) pages was marked accordingly.  \n   FINDINGS OF FACT AND CONCLUSIONS OF LAW \nOn the basis of the record as a whole, to include the aforementioned documentary evidence, \nother  matters  properly  before  the  Commission,  and  after  having  had  an  opportunity  to  hear  the \ntestimony of the Claimant and observe his demeanor, I hereby make the following findings of fact \nand conclusions of law in accordance with Ark. Code Ann. §11-9-704 (Repl. 2012): \n1. The  Arkansas  Workers'  Compensation  Commission  has  jurisdiction  of  the  within \nclaim. \n \n2. The  employee-employer-carrier  relationship  existed  at  all  relevant  times,  including \nJanuary 14, 2021. \n \n3. The remaining stipulations set forth above are hereby accepted. \n \n4. The evidence preponderates that the peripheral nerve stimulator recommended by the \nClaimant’s  treating  physician,  Dr.  Johnathan Goree, is  reasonable  and  necessary \ntreatment for the Claimant’s compensable right shoulder injury of January 14, 2021. \n \n                                                             Hearing Testimony  \n The Claimant, age 36, has a nursing degree and EMT training.  He graduated from high \nschool in 2006.  He attended UAMS School of Health and Related Professionals.  The Claimant \n\nMitchell- H100964 \n \n5 \nalso attended Baptist Health College in Little Rock.  He holds an LPN (licensed practical nurse) \nlicense, which he obtained in 2015.  The Claimant obtained his EMT license in 2007. \n Since leaving high school and before going to work as an EMT, the Claimant performed \nentry  level  mechanic-type  work.    Next,  the  Claimant worked  for eleven  years as  an  EMT  for \nMEMS in Little Rock.  He testified that he also did ambulance work, and then in 2015 he obtained \nhis nursing degree and started working in critical care, in an acute hospital setting.  The Claimant \nalso worked back and forth on an ambulance.  According to the Claimant, he has always worked \non cars on the side. \n The Claimant confirmed that he worked for Metropolitan EMS until around 2019, and then \nhe went to work at Amberwood Health and Rehab in Benton.  There, the Claimant worked as an \nLPN  in his  first  nursing  job.   Next, he  went  to  work  for  St.  Vincent,  which  is  also called \nCornerstone Hospital.  He confirmed that he worked in critical care.  The Claimant confirmed that \nhe left Cornerstone during COVID. \n Per the Claimant, he started working at Parker Audi Automotive in August or September \nof 2020.  He confirmed that he went straight from Cornerstone over to Parker.  When the Claimant \nleft there, he went to work full-time with Parker.  The Claimant testified that he left the hospital \nsetting strictly due to “burnout.”  He explained that he had been in medicine all of his life and it \nwas time for a change.  According to the Claimant, COVID threw nurses over the edge, and he \nhad to escape that for a bit.  \n He  confirmed  that  he  was  hired  as  a  mechanic  at  Parker  as  a full-on technician. The \nClaimant testified that his job duties included basic maintenance, and in a brief time he was pulling \nmajor parts and engines from cars.   \n\nMitchell- H100964 \n \n6 \n On January 14, 2021, the Claimant was injured while at the tire mounting machine, which \ngrips the wheel and tire on its side to change the tires out.  He essentially testified that Audi uses \na very tight-walled tire that makes them high tensile tight, and they have to use tire irons and the \nmachine to break the bead off and get the tire demounted.  When the Claimant pulled back the tire \niron, he felt an extremely sharp pain in his right shoulder.  He testified that the pain lasted for a \nfew minutes and then it subsided.  The Claimant testified that of course he did not think anything \nof it at the time.  He took a break and then went to lunch.  The next day, the Claimant realized that \nhe had a problem, and it started flaring up when he was doing his other work. \n He confirmed that he injured his shoulder on January 14, 2021, and that the Respondents \naccepted his injury as compensable and paid for his medical treatment.  The Claimant testified that \nhe had what they call a SLAP tear, superior labrum anterior to the posterior tear, which is a right \ntear in the larum about 60% of the way around.  He was sent to Dr. Reynolds for treatment of his \nright shoulder injury.  However, the Claimant explained that the first medical person he saw was \nat an urgent care clinic affiliated with CHI St. Vincent, in Little Rock.  There, the Claimant was \ndiagnosed with  a  torn  rotator  cuff.    As a  result,  the  Claimant referred over  to  orthopedics for \nfurther treatment and evaluation by Dr. Reynolds.  At that point, the Claimant found out that he \nhad a SLAP tear.  The Claimant underwent surgery on March 2, 2021, under the care of Dr. Kirk \nReynolds, in the form of an arthroscopic procedure to repair the tear.  Following this first surgery, \nDr. Reynolds reported that the Claimant was doing well, and physical therapy was ordered.  \nThe  Claimant  confirmed  that  he  had  worsening  pain by  August  2021.    As  a  result,  in \nSeptember of 2021 another MRI was performed.  This MRI showed a tear.  The Claimant testified \nthat  it  had  reopened,  which  was  a  re-tear in  the  same  place.    He  returned  to  Dr.  Reynolds  on \n\nMitchell- H100964 \n \n7 \nNovember  16, 2021, and he performed another arthroscopic procedure on the Claimant’s right \nshoulder.  Next, the Claimant underwent some platelet rich plasma (PRP) injections by Dr. Vargas.  \nThe  Claimant  testified  that  Dr.  Vargas  also did  the  cortisone injections as  well  as the PRP’s. \nHowever, the Claimant testified that unfortunately, the PRP’s did not help relieve his symptoms, \nnor did the cortisone shots work.  Per the Claimant, he underwent two PRP’s with no improvement.   \nOn  May  3, 2022, the  Claimant  underwent an  FCE with  reliable  results,  with  52  of  52 \nconsistency measures.  He was given a medium duty work restriction.  The Claimant followed up \nDr. Reynolds on May 19, 2022, and he released the Claimant from his care with a 6% whole body \nimpairment rating.  \nThe Respondents then sent the Claimant for an Independent Medical Evaluation/IME with \nDr. Carlos Roman.  The Claimant confirmed that he saw Dr. Roman on June 6, 2022.  At that time, \nthe Claimant confirmed that he was diagnosed with right shoulder weakness and chronic shoulder \npain. \nPer the Claimant, his visit with Dr. Roman went terrible.  The Claimant testified that he \nwas downplayed from the very beginning.  According to Claimant, the vibe he got from walking \ninto that office and being offered a medical marijuana card was just off-putting to him for someone \nbeing in medicine and knowing that he was a nurse and could not do that.  He specifically testified \nthat  his  SLAP  procedure  and “whole  illness was downplayed.”  The  Claimant  testified  that  he \nwants  to  get  off  the  pain  medicines.  He  confirmed  that  he  filed  a  change  of  physician  to  Dr. \nJohnathan Goree  following  that  office  visit.   The  Claimant  admitted  that  he  underwent  a \nradiofrequency ablation for his right shoulder. \n\nMitchell- H100964 \n \n8 \nThere are two types of temporary blocks that were used, some other drug and Lidocaine in \nthe targeted area that they planned to do the ablation in.  Two temporary blocks were done and \n80% was successful.  According to the Claimant, then the actual ablation was done.  Unfortunately, \nthe  ablation  targeted  area  did  not  work,  so he still had the  exact  amount  pain.   As  a  result,  Dr. \nGoree referred the Claimant for surgical intervention by Dr. Lawarence O’Malley.  On April 27, \n2023, Dr. O’Malley performed a right shoulder scope due to another posterior labral tear.   \nDr. O’Malley noted on October 2, 2023, that the Claimant was at maximum medical \nimprovement and assigned a 10% whole body rating and referred the Claimant back to Dr. Goree \nfor pain management.  The Claimant confirmed that the Respondents accepted both of his ratings.  \nHe testified that after the third surgery, Dr. Goree and Dr. O’Malley communicated and consulted \nabout his shoulder  condition.   The  Claimant  explained  that  Dr.  Goree  has  recommended  the \nperipheral  nerve  stimulator  to  block  those  messuages  being  sent  from  the  arm  to  the  brain.   \nAccording  to  the  Claimant,  the  peripheral  nerve  stimulation  is a battery  pack  with  low  voltage \nfrequency.  He testified that this device calms the nerve pain, although it does not take it completely \naway.   \nWith respect to the stimulator, the Claimant testified that the battery pack could be placed \nin  the  chest  cavity  or  externally  with  an adhesive  pouch  to  hold  the  actual  transmitter.   The \nClaimant testified that initially the device is placed externally on the body.  If it is determined that \nthe device is helping, then they will implant it in his chest wall.  The Claimant testified that  \ncurrently,  Dr.  Goree  has  him  on  Oxycodone  5-miulligram,  PRN, which  means he  takes  it  as \nneeded.    According  to  the  Claimant,  sleep  disturbance  can  be  a  big issue, so  he  put  him  on \nNortriptyline to help with his sleep, and that is the only thing that has worked so far to dull the \n\nMitchell- H100964 \n \n9 \npain down some so that he can rest at night.  However, the Claimant testified that the goal is to get \nhim off the medications with this instrument.   \nUnder further questioning the following exchange took place: \nQ Okay.  Tell me -- I want you to describe the pain that you feel.     \nA The pain that I feel, dependent on what I’m doing, if it’s at rest it’s a throbbing dull \npain, almost like an arthritic pain that doesn’t go away.  Anything above shoulder or chest \nheight with my arm being raised is a sharp, feels like almost tearing as soon as I raise my \narm, and just being at a standstill can almost move my body and hear that joint creak, which \nI’ve brought up a few times, but it’s part of the joint being fused back together so it’s \nconstant pain, either sharp or dull.  \n \nThe Claimant confirmed that after his doctors released him to medium duty work, his   \nemployer tried to put him back to work.  According to the Claimant, he knew that this was a tactic \nto get him to return to work.  However, the Claimant testified that as soon as he was back at work, \nthe next day they had him lifting 70-pound batteries from the back of vehicles.  As a result, the \nClaimant decided not to continue his employment with Parker Audi.    \n He confirmed that he has a personal hobby farm.  It is about two acres, and they use half \nof it to raise chickens.  According to the Claimant, they do not really do commercial farming or \nanything.    He stated that  they  have  eight chickens and  eight  ducks.   Also,  they  grow  tomatoes, \nwhich are grown only seasonally.  The Claimant’s long-time girlfriend runs a flower farm, and she \ngrows  just  about  everything.    He  confirmed  that  he  is  half owner in the Front  Porch Farmer’s \nMarket, which is a community cooperative market.  They support Arkansas farmers.  The Claimant \ntestified that he made $5000.00 from this business last year.  \n On cross-examination, the Claimant confirmed that his deposition was taken on November \n9,  2023.  The  Claimant  admitted  that  following  his  second  surgery  with  Dr.  Reynolds,  he \nunderwent  some  injections  by  Dr.  Vargas.    He  agreed  that  the  injections  did  not  help, so  Dr. \n\nMitchell- H100964 \n \n10 \nReynolds sent him to Dr. Roman for pain management.  He confirmed that he did not get along \nwith Dr. Roman due to a personality conflict, and that this is the reason he obtained a change of \nphysician to treat with Dr. Goree.  The Claimant confirmed that Dr. Goree’s nurse practitioner sent \nhim to Dr. O’Malley for his third surgery to be performed.  He agreed he testified in his deposition \nthat the third surgery did help some with stability.   \nThe Claimant confirmed that to date, all of his medical treatment has been paid for by the \nworkers’ compensation carrier.  He agreed that currently he is working sixteen hours a week at \nBaptist Health College.  The Claimant admitted that he testified in his deposition that if full-time \nwork became available, he would probably take it.   \nUnder further questioning, the Claimant admitted that he is not under any restrictions from \na doctor.  During his deposition, the Claimant testified that he oversees the operations of the farm \nproduct at market as part of his work with the Farmer’s Market.  Besides his sleep medication and \nOxycodone, the Claimant takes over-the-counter medications for really severe pain.  The Claimant \nconfirms  that  he  takes Oxycodone only  in  the  evenings  because  he  likes  to  be  able  to  function \nclearly.   \nThe  Claimant  gave  the  following  explanation  regarding  the  current  condition  of  his \nshoulder: \nIt is not good.  From just a layperson’s standpoint or a medical person’s standpoint, \nI deal with a lot of pain.  It has changed my personality: it has changed my sleep patterns; \nmy relationships; and my jobs.  It has affected single portion of my life. \nThe shoulder itself is trashed, but the only way without saying anything about what \nthe doctors said is, you know, we’ve got to kick the can down the road per se before I can \nget a shoulder replacement, and that’s in my 50’s, if I’m lucky. \n \nThe Claimant testified that he would like to get off of the pills because he knows where \n\nMitchell- H100964 \n \n11 \nthat can go.  He testified that he thinks it is unfair to keep going in this condition and being in this \nshape at the age of 36.  According to the Claimant, he is unable to throw a ball with his son.  His \nson is 10 and plays baseball.  The Claimant confirmed that he is in constant pain.     \n     Medical Evidence  \n A  review  of  the  medical  records shows that  on  January  19,  2021,  the  Claimant  sought \nmedical  treatment  at  CHI  St.  Vincent  Infirmary in  Little Rock due  to  a “right  shoulder  injury.”  \nThe Claimant reported that he injured his right shoulder at work while changing a tire.  Progress \nNotes authored by Leanne Glidewell, APRN, show that the Claimant was assessed with, “1.  Injury \nof right rotator cuff, initial encounter- S46.0001A (Primary) 2.  Acute pain in my right shoulder -\nM25.511.  3.  Accident  at  workplace -Y99.0.”  Glidwell opined  that the Claimant  likely  had  a \nrotator cuff injury given his acute right shoulder pain and limited range of motion. As a result, she \nplaced the Claimant on limited work duty and referred him to an orthopedic specialist. \nThe Claimant underwent an evaluation by Dr. Kirk Reynolds on January 19, 2021, due to \na  chief  complaint  of  right  shoulder  pain.   At  that  time, four (4) Views  of  the Claimant’s right \nshoulder were obtained. \nIMAGING \n4 [sic]VIEWS of the right shoulder were obtained today and personally reviewed.  \nGlenohumeral alignment and architecture are normal.  There is no AC joint or \nglenohumeral arthritis.  The humeral head is well centered in the glenoid without \nevidence of posterior subluxation of superior escape. Type 1 acromion. \n \nASSESSEMENT \nRight shoulder pain, instability, and mechanical symptoms consistent with labral \npathology. \n \nPLAN \nDiagnosis and  treatment  discussed  with  justin(sic)  in  clinic  today.    Given  his  pain, \nmechanical symptoms, weakness and instability I recommend an MRI arthrogram of the \nright  shoulder  to  better  evaluate  biceps  anchor,  posterior  labrum  and  other  intra-\n\nMitchell- H100964 \n \n12 \narticular/periarticular  structures.    I  will  have  him  return  for  re-evaluation  once  that  is \navailable for review in the interim, he will remain on modified duty at work with no lifting, \npushing or pulling with the right upper extremity and no work above shoulder level.  He \nhas not reached MMI.   \n \nIt is my professional medical opinion that 100% of his current complaints and pathology \nare not directly and causally related to his injury which occurred at work on the date stated \nabove. \n \nOn February 4, 2021, the Claimant underwent an MRI Right Shoulder Direct Arthrogram: \nIMPRESSION: \n1. Suspected posterior  glenoid  hypoplasia  with  tearing  of  the  posterior  labrum.    Labral \ntearing  extends  from  the  11:00  position  posterior  superiorly  to  the  6:00  position \ninferiorly.  There is no definite involvement of the biceps labral anchor or intra-articular \nbiceps.   \n2. Heterogeneous  signal  of  the  central  and  posterior  glenoid  cartilage is suspicious  for \nlow-grade chondromalacia.  No definite high-grade cartilage defect or subchondral cyst \nformation. \n3. No evidence of rotator cuff tear. \n \nFluoroscopy Guided Right Shoulder Injection for Direct MR Arthrography was done on  \n \nthat same  with an IMPRESSION: of “Successful fluoroscopy guided right shoulder injection for \ndirect MR arthrography.”   \n           The Claimant underwent right shoulder surgery on March 2, 2021, by Dr. Reynolds: \nPREOPERATIVE DIAGNOSES: \n1. Right shoulder posterior subluxation with posterior labral tear.  \n2. Right shoulder unstable, type II SLAP tear. \n \n            POSTOPERTIVE DIAGNOSES: \n1. Right shoulder posterior subluxation with posterior labral tear.  \n2. Right shoulder unstable, type II SLAP tear. \n3. Right shoulder traumatic arthroscopic chondroplasty of the glenoid. \n \nPROCEDURES PERFORMED: \n1. Right shoulder diagnostic arthroscopy with posterior stabilization/labral repair. \n2. Right shoulder arthroscopic repairment of unstable, type II SLAP tear. \n3. Right shoulder arthroscopic chondroplasty of the glenoid. \n \nDr. Reynolds saw the Claimant in follow-up care on April 8, 2021, after performing a right  \n\nMitchell- H100964 \n \n13 \nshoulder arthroscopy with posterior stabilization/labral repair, repair of an unstable type II SLAP \ntear and chondroplasty of the glenoid on March 2, 2021.  At that time, Der. Reynolds returned the \nClaimant back to work on modified duty. \n            On May 19, 2021, the Claimant returned to Dr. Reynolds for a follow-up evaluation of his \nright shoulder injury.  Overall, the Claimant was doing well eleven (11) weeks status post- shoulder \narthroscopy.  However, Dr. Reynolds noted that the Claimant still had some functional weakness \nand  residual  stiffness  in his  right shoulder.    Therefore,  Dr.  Reynolds  recommended  that  the \nClaimant continue with formal physical therapy.  He returned the Claimant to modified duty work.  \nDr. Reynolds noted that the Claimant continued to be restricted to no work above shoulder level, \nwith the right upper extremity.  At that time, Dr. Reynolds also stated that the Claimant was not at \nMMI for his right shoulder injury. \n            Dr.  Victor  Vargas  evaluated  the  Claimant  on  July  26, 2021, due  to  a  chief  complaint  of \nright  shoulder  pain.  He performed a “Right shoulder glenohumeral joint intra-articular  steroid \ninjection under ultrasound needle guidance.” \n           On August 18, 2021, the Claimant returned to Dr. Reynolds for an office visit.  At that time, \nthe Claimant had undergone the joint injection by Dr. Vargas.  Per this Clinic Note, the Claimant  \nwas  now  five  and  one-half  months (5½)  out  from  right  shoulder  arthroscopy  with  posterior \nstabilization and SLAP repair.  Dr. Reynolds noted that the Claimant’s symptoms were actually \nworsening, and he had more stiffness and loss of rotation at the time.  The Claimant also reported \n fairly  significant  pain  in  his  shoulder  with bicep provocation  maneuvers.    Dr.  Reynolds \nrecommended  that  the  Claimant  undergo  a  repeat  MRI  arthrogram  to  get  a  better  idea  of  the \n\nMitchell- H100964 \n \n14 \nintegrity of his labral repair and biceps anchor.  He again opined that the Claimant had not reached \nMMI.      \n            On  September  14,  2021,  the  Claimant  underwent  an  MRI  of  the  right  shoulder  with  the \nfollowing impression: “Orthopedic anchors in the glenoid.  Posterior labral tear from 7-11 o’clock \nlarge sub labral recess or tear of the superior labrum.” \n           Dr. Reynolds saw the Claimant for a follow-up visit on September 15, 2021.  At that time, \nthe Claimant was assessed with “Persistent right shoulder pain with recurrent posterior labral tear \nand  cystic  changes  at  the  superior  glenoid  labrum  in  the  region  of  his  prior  SLAP  repair.”  Dr. \nReynolds  further  noted  that  the  Claimant  had  underlying  posttraumatic  arthritis\\traumatic \narthropathy of the glenohumeral joint. \nOn November 16, 2021, Dr. Reynolds authored an Operative Report: \nPREOPERTIVE DIAGNOSES: \n1. Right shoulder arthrofibrosis. \n2. Right shoulder recurrent posterior-superior labral tear. \n \nPOSTOPERTIVE DIAGNOSES: \n1. Right shoulder arthrofibrosis. \n2. Right shoulder recurrent posterior-superior labral tear. \n3. Right shoulder subacromial and subdeltoid bursitis. \n \nPROCEDURES PERFORMED: \n1. Right shoulder open, subpectoral biceps tenodesis. \n \n2. Right shoulder arthroscopic synovial biopsy for culture with removal of prior, failed \nsutures,  debridement  of  the  glenoid  labrum,  chondroplasty  of  the  glenoid  and \nsubacromial subdeltoid bursectomy.   \n \n           The Claimant returned to the office of Dr. Reynolds on December 1, 2021, for a follow-up \nvisit of his chronic right shoulder pain.  Overall, the Claimant was doing well at two weeks out \npost right shoulder arthroscopy.  Dr. Reynolds directed the Claimant to continue physical therapy \n\nMitchell- H100964 \n \n15 \nand returned the Claimant to modified duty along with instructions to wear a sling for two more \nweeks.  At that time Dr. Reynolds opined that the Claimant was not at MMI for his right shoulder \ninjury. \n            On February 22, 2022, the Claimant underwent “Right shoulder glenohumeral joint intra-\narticular PRP injection under ultrasound needle guidance,” which was performed by Dr. Vargas. \nThis  procedure  was  performed  because  the  Claimant  had  an  indication  of  right  shoulder  pain, \narthrofibrosis, and a SLAP tear.    \n         Dr. Vargas performed a second injection on the Claimant right shoulder on March 10, 2022. \nAccording to Dr. Vargas’ notes, the Claimant continued to complain of aching, dull and throbbing \npain in his right shoulder.  The Claimant continued to take pain medication.  However, Dr. Vargas \nrecommended that the Claimant for referral to a pain management specialist.   \n        On April 18, 2022, the Claimant returned Dr. Reynolds for reevaluation of his right shoulder \npain.   The  Claimant  was  now  status  post of  two  separate  ultrasound-guided  glenohumeral  joint \nplatelet  right  plasma  injections.   Dr.  Reynolds  reported  that  unfortunately  neither  of  these \nprocedures  provided  any  significant  pain  relief. At  that  time,  Dr.  Reynolds  explained  to  the \nClaimant that he had a fairly significant injury to his right shouler that is unlikely to completely \nresolve  with  regard  to  regaining  full  range  of  motion  and  complete  pain  relief.  The  Claimant \nreported  to  Dr.  Reynolds  that  he  had  changed  his  line  of  work  due  to  his  shoulder  injury.  \nTherefore,  Dr.  Reynolds discussed  with  the  Claimant  a  Functional  Evaluation  to figure  out the \nobjective functional status of his shoulder.  Dr. Reynolds stated that the Claimant had not reached \nMMI for his shoulder injury.    \n\nMitchell- H100964 \n \n16 \n        The Claimant was reevaluated on May 19, 2022, by Dr. Reynolds for his right shoulder injury. \nPer  these  medical  notes,  Dr.  Reynolds  reported  he  had  reviewed  the  Claimant’s  Functional \nCapacity  Evaluation,  which  was  done  May  3,  2022.    Per  these  notes,  the  Claimant  put  forth a \nreliable effort with 52 of 52 consistency measure within expected limits.  Dr. Reynolds opined that \nbased on the Claimant’s functional abilities he could perform work-related tasks in the “Medium,” \nclassification  of work  as  defined  by  the  US  Department  of Labor’s  guidelines.    It  was  Dr. \nReynolds’ professional opinion that the Claimant had reached MMI on his right shoulder injury. \nTherefore, Dr. Reynolds returned the Claimant to work with the current restrictions as detailed on \nhis FCE.  Dr. Reynolds opined that no further surgical treatment or physical therapy was warranted. \nHowever, Dr. Reynolds stated that the Claimant does have objective loss of function in his right \nshoulder  associated  with  post-traumatic  arthritis  of  the  glenohumeral  joint  secondary  to  the \ntraumatic chondral defect of the posterior glenoid.  He went on to state that the pain associated \nwith this objective defect is certainly an impact on his ability to perform activities of daily living \nas well as any work tasks.  Dr. Reynolds wrote in pertinent part: “It is outside of the scope of my \npractice to manage his pain long-term, so I recommend a referral to a pain management specialist. \nHopefully he will be able to find alternative ways to manage his pain and posttraumatic arthritis \nwhile limiting narcotic utilization.  It is my professional medical opinion that this is directly and \ncausally related to his injury at work despite the  fact that pain is identified in the AMA Guides \nwhen calculating an impairment rating. Utilizing the AMA Guides to the Evaluation of Permanent \nImpairment,  Fourth Edition,  Dr. Reynolds  assessed  the  Claimant  with  a  10%  partial  permanent \nimpairment to the right upper extremity associated with loss of shoulder forward abduction and \ninternal  rotation.  This amounted  to a  6%  partial  permanent  impairment  to  the  whole  person \n\nMitchell- H100964 \n \n17 \naccording to Table 3 on page 20.  The above statements were made with a reasonable degree of \nmedical certainty by Dr. Reynolds. \n       On June 6, 2022, the Claimant underwent an Independent Medical Evaluation by Dr. Carlos \nRoman due to his chronic right shoulder pain.  Dr.  Roman assessed the Claimant with “1.  Chronic \nright shoulder pain.  2. Status post posterior labral tear.  3. Right shoulder weakness.”  It appears \nthat Dr. Roman prescribed a medication regimen for the Claimant’s right shoulder pain that \nincluded opiates.  However, the Claimant discussed the long-term use of opiates with the Claimant.  \nAs an LPN Dr. Roman stated that the Claimant understood the concerns there.  \n           The Claimant was evaluated by Dr. Johnathan Goree on September 13, 2022.  At that time, \nthe  Claimant  presented  to  Dr.  Goree  for  an  initial  evaluation  of  his  chronic  post-surgical  right \nshoulder  pain.  The  Claimant  reported  that  he  has  severe  pain  with  extension  of  his  arm  and \nshoulder.  He reported that his pain was improved with Hydrocodone.  Dr. Goree’s assessment \nwas “Chronic pain. Post surgical shoulder pain,” for  which he discussed with the Claimant \nshoulder  RFA (Radiofrequency  Ablation) if  the  Claimant  does  not  have  surgical  options.    He \ncontinued the Claimant’s medication regimen, which included Hydrocodone. \n          On  October  7,  2022,  the  Claimant  was reevaluated  by  Dr.  Reynolds.    The  Claimant  was \nnineteen (19) months post arthroscopic repair of  a right SLAP tear and posterior labral tear and    \neleven  (11)  months  status  post  arthroscopic  lysis  and  adhesives  with  suture  anchor  removal, \nbursectomy  and  open  biceps  tenodesis.  Dr.  Reynolds  opined  that  the  Claimant  continued  with \nfairly significant pian in  the right shoulder girdle, which does limit his functional capacity.  He \nspecifically opined, in relevant part: “It is obvious on clinical examination that his pain behaviors \nare consistent with physical examination findings.”  It was Dr. Reynolds’ professional opinion that \n\nMitchell- H100964 \n \n18 \nthe Claimant does not require surgical intervention.  Dr. Reynolds agreed with Dr. Goree’s \nrecommendation for diagnostic analgesic injection in the periarticular sensory nerve to determine \nrelief  of  pain.  In  the  setting  of  a  good  response  Dr.  Reynolds  recommended  a  radiofrequency \nablation  as  a  pain-relieving  modality.   His assessment was “1.  Pain of right shoulder joint.  2. \nMechanical  complication  of  internal  orthopedic  device  implant  AND/OR  graft.    3.  Traumatic \narthropathy of right shoulder.” \nThe Claimant presented to the clinic of Dr. Goree on February 3, 2023.  Per these notes,  \nDr. Goree performed left suprascapular, axillary and superior pectoral nerve block on November \n3 and on December 8 with report of significant relief (85%) of pain temporarily.  Then the Claimant \nhad  ablation  on  December  29,  2022,  without  relief.    While  undergoing  attempts  in  treating \nClaimant’s pain procedurally, Dr. Goree provided the Claimant with Hydrocodone.  However, Dr. \nGoree recommended that the Claimant plan for Sprint peripheral nerve stimulation with Dr. Goree \nfor his post-operative shoulder pain and decreased ROM and function.        \nOn March 15, 2023, the Claimant underwent an MRI arthrogram of the right shoulder.  The  \nprior day, the Claimant underwent an MRI arthrogram of the right shoulder on March 14, 2023.  \nTherefore, the Claimant presented to Dr. Lawrance O’Malley on March 27, 2023, to  discuss the \nresults.  The Claimant  reported that his pain was  essentially the same as it was prior to his two \nsurgeries. As a result, he presented to Dr. O’Malley for evaluation and to discuss his options.   Dr. \nO’Malley wrote in relevant part: \nIMAGING: New MRI arthrogram of the right shoulder is available for review today. He \nhas  a  large  posterior  labral  tear  noted.    There  is  also  fraying  of  the  supraspinatus  and \nsubscapularis.  \n \nIMPRESSION: continued right shoulder pain with posterior labral tear.  \n \n\nMitchell- H100964 \n \n19 \nPLAN:  A  Long  discussion  was  had  with  the  patient  today  regarding  his  diagnosis  and \ntreatment options.  We have ruled out a subclinical injection at this time.  He would like to \nproceed with surgical intervention... \n \nThe Claimant returned to Dr. O’Malley for further evaluation following the surgical  \n \nintervention of his chronic right shoulder pain on May 11, 2023.  At that time, the Claimant was \ntwo weeks out from “right shoulder arthroscopy with posterior labral repair.” Overall, the Claimant \nwas doing well.  As a result, physical therapy was ordered       \nOn October 2, 2023, Dr. O’Malley pronounced the Claimant to be at MMI.  He assessed  \nthe Claimant with a 10% whole body impairment.  Dr. O’Malley referred the Claimant for pain \nmanagement with Dr. Goree because the Claimant was still in significant pain.   \n           The Claimant returned to Dr. Goree for evaluation of his severe shoulder pain on March 12, \n2024.  Dr. Goree noted that the Claimant was doing decently with his medication, which included \nHydrocodone.  Although the Claimant’s pain had improved with the third surgical intervention, he \ncontinued with some severe pain.  Dr. Goree discussed with the Claimant specific treatment plans \nincluding alternative nonpharmacologic therapies.  Specifically, Dr. Goree opined, “In my opinion \nthe  potential  for  opioid  abuse  or diversion  is  outweighed  by  the  potential  benefits  of  opioid \ntherapy.”  They discussed spinal cord stimulation for the Claimant’s pain, but this treatment had \nbeen  denied by the workers’ compensation carrier for another surgery.  However,  the Claimant \nexpressed an interest in this treatment. \nOn May 28, 2024, Dr. Roman answered questions posed by the workers’ compensation  \nCarrier regarding the peripheral nerve stimulator.  Dr. Roman opined that the stimulator is clearly \nnot indicated.  He stated that the Claimant does not have a neuropathic nerve problem, and he has \nosteoarthritic problems in his right shoulder, which disqualifies him for this treatment.  Dr. Roman \n\nMitchell- H100964 \n \n20 \nalso stated  that  looking  at  articles  in  the  literature  going  back  to  2022,  evidence  based  clinical \nguidelines of the American Society of Pain Neuroscience views of implantable peripheral nerve \nstimulation treatment of chronic pain, the main indications  here for this treatment are for chronic \nmigraine  headaches,  hemiplegia  of  the  shoulder  via  stimulation  of  nerves  innervating  the \nmusculature, failed back surgery, extremity neuropathy and post amputation pain, in particular for \nneuropathic  pain  processes.  Dr.  Roman  stated that further  treatments for the  Claimant  would \ninclude reasonably include maybe occasional steroid injections and at some point, he might be a \ncandidate for shoulder replacement, but no further surgical intervention.  He also stated that the \nClaimant might benefit from anti-inflammatories and possible occasional intra-articular shoulder \ninjection with steroid to see if it will offer relief.  Dr. Roman stated that the Claimant has chronic \nright shoulder pain, he got an osteoarthritis right shoulder as is related to the injujry.                \n                                                                 Adjudication \n \nReasonable and Necessary Medical Treatment: \nThe Respondents accepted the Claimant’s January  14, 2021, right  shoulder injury  as \ncompensable.    They  have paid for extensive medical  treatment  and  temporary  total  disability \ncompensation to and on behalf of the Claimant as a result of his right shoulder injury. The Claimant \nnow  asserts  that  he  is  entitled  to additional reasonable  and  necessary  medical  treatment, for  his \nright shoulder injury in the form of a peripheral nerve stimulator as recommended by Dr. Johnathan \nGoree.  \nAn  employer  shall  promptly  provide  for  an  injured  employee  such  medical  treatment  as \nmay be reasonably necessary in connection with the injury received by the employee.  Ark. Code \n\nMitchell- H100964 \n \n21 \nAnn. §11-9-508(a) (Repl. 2012).  The Claimant must prove by a preponderance of the evidence \nthat  the  medical  treatment  is  reasonably  necessary in  connection  with  the  injury  received \nemployee. Jordan v. Tyson Foods, Inc., 51 Ark. App. 100, 911 S.W. 2d 593 (1995).  \nPreponderance  of  the  evidence  means  the  evidence  having  greater  weight  or  convincing \nforce.  Smith v. Magnet Cove Barium Corp., 212 Ark. 491, 206 S.W.2d 442 (1947). \nAfter  reviewing  the  evidence  in  this  case  impartially,  without  giving  the  benefit  of  the \ndoubt to either party, I find that the Claimant proved by a preponderance of the credible evidence \nthat  the  medical  treatment  in the  form  of peripheral  nerve  stimulator,  as  recommended by  Dr. \nGoree is reasonably necessary in connection with the admittedly compensable right shoulder injury \nreceived by the Claimant on January 14, 2021. \nThe  Claimant  has  training  and  skills  in  mechanic  type  work.    He  also  has  training  as  a \nnurse.  Nevertheless, it is undisputed that the Claimant sustained a compensable injury to his right \nshoulder on January 14, 2021, while changing out a tire.  At the time of the Claimant’s injury, he \nworked for Parker Audi as a mechanic.  The Respondents accepted the injury as compensable and \npromptly  began  providing  the  Claimant  with  medical  treatment  in  connection  with  the  injury \nreceived by the Claimant.  \nAn MRI was performed of the Claimant’s right shoulder which revealed a torn labrum.  \nThe  Claimant  underwent  a  right  shoulder  arthroscopy  with  posterior  stabilization,  SLAP  repair \nand  chondroplasty  of  the  glenoid,  on  March  2,  2021,  by  Dr.  Reynolds. Following  this  surgical \nintervention,  the  Claimant  initially  did  well.    However,  he  developed  worsening  symptoms  of \nshoulder pain  and  stiffness.   The  Claimant  underwent  a  round  of  physical  therapy.  Also, Dr. \nVargas   performed   ultrasound-guided   glenohumeral   joint   corticosteroid   injections for the \n\nMitchell- H100964 \n \n22 \nClaimant’s complaints of ongoing right shoulder pain and other related symptoms.  Unfortunately, \nthe Claimant received no significant improvement after the injections.  As a result, Dr. Reynolds \nordered a repeat MRI arthrogram of the shoulder.    \nOn September 14, 2021, the Claimant underwent an MRI which revealed “a large posterior \nlabrum tear” and other objective  findings as  detailed  above.    Dr.  Reynolds  performed a  second \nright  shoulder  surgery  in  the  form  of  an  arthroscopy  on  November  16,  2021.  The  Claimant \nunderwent another round of physical therapy, per protocol.  On February 22, 2022, and March 10, \n2022,  the Claimant underwent right  shoulder  glenohumeral  joint  intra-articular  injections under \nultrasound needle guidance by Dr. Vargas.  However, neither of these provided the Claimant with \nany significant relief from his right shoulder pain.  Ultimately, following the Claimant’s second \nright shoulder surgery, he was assessed with an impairment rating of 6% to the body as a whole \nby Dr. Reynolds on May 19, 2022.  Despite these treatment modalities, the Claimant continued \nwith significant right shoulder pain and other related symptoms, for which Dr. Reynolds referred \nhim to pain management.  \nThe Claimant came under the care of Dr. Johnathan Goree for his chronic right shoulder \npain,  on  September  13,  2022.   At  that  time,  the  Claimant  continued  with  shoulder  pain  despite \nbeing  on  a  medication  regimen  that  included  Hydrocodone  for  pain.  Therefore,  Dr.  Goree \nperformed nerve blocks for which the Claimant reported significant relief of his pain temporarily. \nDr.  Goree  also  performed an ablation  on  December  29,  2022,  with  no  relief  of the Claimant’s \nchronic shoulder pain and other related symptoms. \nOn  April  27, 2023, the  Claimant  underwent  a  third  surgery on his  shoulder,  which  was \nperformed by Dr. O’Malley, in the form of a right shoulder scope with posterior labral repair.  In \n\nMitchell- H100964 \n \n23 \nOctober  2023,  Dr. O’Malley pronounced the Claimant to be MMI for his shoulder surgery  and \nassessed a 10% whole body rating.  The Claimant returned to Dr. Goree for pain management, and \nhe  now  recommends  a  peripheral  nerve  stimulator  for relief of the Claimant’s chronic shoulder \npain.  The Respondents have denied this treatment modality.     \nDespite having undergone multiple forms of conservative treatment and three surgeries to \nhis right shoulder, the Claimant has continued with severe chronic right shoulder pain. Currently \nthe Claimant takes Hydrocodone, a sleeping pill and other over-the-counter medications for right \nshoulder pain.  However, the Claimant is also a Licensed Practical Nurse (LPN) and is well aware \nof the concerns surrounding the long-term use of opiates.  The Claimant wishes to try this treatment \nmodality,  the peripheral  nerve  stimulator  for  relief  of  shoulder  pain.    Although  Dr.  Roman  has \nopined that this treatment is not indicated, he has opined that the Claimant is in need of additional \nmedical  treatment  for  his  shoulder,  which  includes  injections  and  possibly  a  total  shoulder \nreplacement  in  the  future. Dr.  Goree has  specifically opined that  he  is  of  the opinion  that  the \npotential for opioid abuse or diversion is outweighed by the benefit of opioid therapy.” I find that \nGoree’s opinion should be afforded weight concerning that he is the Claimant’s treating physician \nand because this treatment modality will give the Claimant the opportunity to get some relief of \nhis chronic shoulder symptoms via the implementation of a nonpharmacologic alternative.  \nThe  Claimant  underwent an  FCE with  reliable  results.    His  testimony  was  credible  and \nconvincing regarding his ongoing pain despite  extensive conservative and three surgeries to his \nshoulder.  The Claimant’s testimony was also corroborated by the medical records.   He expressed \na genuine concern for the long-term use of Hydrocodone for relief of his symptoms. The Claimant \nhas  symptoms  that  are ongoing, and  they  have  resulted  directly  from  his  compensable right \n\nMitchell- H100964 \n \n24 \nshoulder injury  of  January  2021.   The medical  records  show  that  the Claimant’s clinical \nexaminations  and  pain  behaviors  are  consistent  with  his  physical  examination  findings. The \nClaimant has been very compliant and aggressive in obtaining relief of his shoulder pain without \nthe  use  of  opiates. However, the  Claimant  has  exhausted  majority  of the commonly  recognized \nforms  of  conservative treatment  modalities and  three  surgical  interventions  relief  of his  right \nshoulder pain with only temporary relief of his pain.   Aside from heavy narcotics and opiates, the \nClaimant’s options are extremely limited.  For these reasons, I have attached minimal weight to \nDr. Roman’s opinion to the contrary and given significant weight to Dr. Goree expert opinion.   \nAccordingly I  find  that the  Claimant  proved by  a  preponderance  of evidence that  the \nmedical treatment in the form of a peripheral spinal stimulator is reasonably necessary treatment \nfor the injury received by the Claimant on January 14, 2021.   \n          AWARD \n \nBased  on  the forgoing findings  of  fact  and  conclusions  of  law,  I  find  that  the  Claimant \nproved his entitlement to the peripheral nerve stimulator for his compensable right shoulder injury \nof January 14, 2021, as recommended by his treating physician, Dr. Johnathan Goree. \nIT IS SO ORDERED. \n \n \n \n              _______________________________ \n              CHANDRA L. BLACK \n             ADMINISTRATIVE LAW JUDGE","preview":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION CLAIM NO.: H100964 JUSTIN P. MITCHELL, EMPLOYEE CLAIMANT PARKER AUDI, EMPLOYER RESPONDENT CENTRAL ARKANSAS AUTO DEALERS, SIF, CARRIER RESPONDENT RISK MANAGEMENT RESOURCES, THIRD PARTY ADMINISTRATOR RESPONDENT OPINION FILED NOVEMBER 12, 2024 A hearing was held before ...","fetched_at":"2026-05-19T22:46:21.688Z","links":{"html":"/opinions/alj-H100964-2024-11-12","pdf":"https://www.labor.arkansas.gov/wp-content/uploads/MITCHELL_JUSTIN_H100964_20241112.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}