{"id":"alj-H104308-2023-07-27","awcc_number":"H104308","decision_date":"2023-07-27","opinion_type":"alj","claimant_name":"Keith Smith","employer_name":"Rock Dental Arkansas, Pllc","title":"SMITH VS. ROCK DENTAL ARKANSAS, PLLC AWCC# H104308 JULY 27, 2023","outcome":"denied","outcome_keywords":["dismissed:1","granted:1","denied:3"],"injury_keywords":["back","fracture","sprain","lumbar","strain","neck","cervical","thoracic"],"pdf_url":"https://labor.arkansas.gov/wp-content/uploads/SMITH_KEITH_H104308_20230727.pdf","source_index_url":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/","filename":"SMITH_KEITH_H104308_20230727.pdf","text_length":26730,"full_text":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION \n \nAWCC FILE No H104308 \n \nKEITH W. SMITH, EMPLOYEE        CLAIMANT \n \nROCK DENTAL ARKANSAS, PLLC, \nAXPM DENTAL MANAGEMENT, EMPLOYER         RESPONDENT \n \nCINCINNATI CASUALTY Co./CINCINNATI \nINSURANCE, CARRIER, CARRIER/TPA          RESPONDENT \n \n \nOPINION FILED 27 JULY 2023 \n \n \nOn  hearing  before Arkansas Workers’ Compensation Commission (AWCC) Administrative \nLaw Judge JayO. Howe, 8 March 2023, Little Rock, Pulaski County, Arkansas. \n \nMs. Laura Beth York and Mr. B. Tanner Thomas, Attorneys-at-Law, Little Rock, Arkansas, \nappeared for the claimant. \n \nMr. Guy Alton Wade, Attorney-at-Law, Little Rock, Arkansas, appeared for the respondents. \n \nI.  STATEMENT OF THE CASE \n \nThe above-captioned case was heard on 8 March 2023 in Little Rock, Arkansas, after the \nparties participated in a prehearing telephone conference on 6 December 2022.  A Prehearing \nOrder was  entered  on that  same  day. The  Order  stated  the  following ISSUES  TO BE \nLITIGATED: \n1.  Whether the claimant sustained a compensable injury to his back by specific incident. \n2.  Whether the claimant is entitled to reasonable and necessary medical treatment. \n3.  Whether the claimant is entitled to temporary total disability (TTD) benefits. \n4.  Whether the claimant is entitled to a controverted attorney’s fee. \nAll other issues were reserved. \nThe parties’ CONTENTIONS, as set forth in their prehearing questionnaire responses, \nwere incorporated by reference into the Prehearing Order. The CLAIMANT CONTENDS: \n\nK. SMITH- H104308  \n2 \n \n1. That he suffered a compensable back injury in the scope and course of employment on \n19 April 2021. \n \n2. That he sought treatment on his own and underwent an MRI that revealed a superior \nend  plate  compression  fracture  at  T-12,  and  corrective  surgery  occurred  on  2  June \n2021. \n \n3. That he was taken off work for 19, 22, and 26 April and then 3, 6, 10, 13, 17, 20, and \n25-38 May. \n \n4. He is entitled to medical benefits, TTD, and that his attorney is entitled to a fee. \n \nThe RESPONDENTS CONTEND: \n1. That the claimant did not sustain a compensable injury in the course and scope of his \nemployment. \n \nThat Order also set forth the following STIPULATIONS: \n1. The AWCC has jurisdiction over this claim. \n2. An employee/employer/carrier relationship existed on 19 April 2021 and at all other \ntimes relevant to this claim. \n \n3. The respondents have controverted this claim in its entirety. \n \n4. The claimant’s  average  weekly  wage  (AWW)  entitles  him  to  the  maximum \ncompensation rates. \n \nTwo (2) WITNESSES provided sworn testimony—the claimant spoke on his own behalf \nand the respondents called Mr. James “Jim” Cavanaugh, who appeared remotely. \nII.  FINDINGS OF FACT AND CONCLUSIONS OF LAW \nHaving reviewed the record as a whole and having heard testimony from the witnesses, \nobserving their 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. \n2. The previously noted stipulations are accepted as fact. \n3. The  claimant  failed  to  prove, by  a  preponderance  of  evidence, that he suffered a \nwork-related injury by specific incident. \n\nK. SMITH- H104308  \n3 \n \n4. Because he failed to prove a compensable injury, the claimant’s request for reasonable \nand necessary medical treatment and TTD benefits are moot and will not be addressed \nbelow. \n \n5. Consistent with the above, the claimant’s attorney is not entitled to a fee. \nIII.  HEARING TESTIMONY and MEDICAL EVIDENCE                                                                                                        \nA. Claimant on direct-examination by Mr. Thomas: \nClaimant, Dr. Keith Smith, has been a dentist practicing his trade since completing \ndental school in 1984.  He began working for respondent, Rock Dental, in their Helena office \naround October of 2020.  A Little Rock resident, Dr. Smith would drive into town on Mondays \nand begin work around 8:00 AM, stay in local housing for the week, and then return home on \nThursday afternoons or evenings.  [TR at 8-11] \nAccording to the claimant, he began most days by starting some tea in the office’s \nbreakroom.  The claimant would go about other things while the tea brewed before going back \ninto the breakroom to get his cup for the morning.  On the morning of 19 April 2021, he was \ndoing just that when he fell going back into the breakroom.  [TR at 12-13]  Dr. Smith claims \nthat he stumbled over one of the chairs around the room’s table.  He was hurting but able to \npull himself up into one of the chairs, where others found him after coming to the room to \ncheck on the commotion. \nDr. Smith explained that he was able to go back and continue a procedure he started \nbefore  going  to  fetch  his  tea.  Sometime  afterwards  a  hygienist  asked  him  to  check  some \npatients on the other side of the office.  About that time, he said, the hygienist suggested that \nhe sit down, saying he was “white as a sheet.”  [TR at 14] \nSpeaking again on the fall, the claimant said that he fell forward, twisting, and that \nhe felt pain almost immediately.  [TR at 17]  After checking the hygiene patients, Dr. Smith \nsaid that the office manager indicated that he should be seen at the local hospital and called \nfor EMS transport via Pafford Medical Services.  The claimant stated his understanding that \n\nK. SMITH- H104308  \n4 \n \nhis condition was ultimately determined to be “bruised up badly but nothing was fractured.” \n[TR at 18]  \nHis next presentation for treatment was on 7 May 2021 at the chiropractic office of \nDr.  Chris  Blackmon, where  spinal x-rays  were  read  to show  compression fractures. [TR  at \n19]  The claimant next saw Dr. Hal Hedges with Little Rock Family Practice (LRFP) on 14 \nMay 2021.  Dr. Hedges ordered an MRI that was performed on 20 May 2021.  [TR at 21-22] \nAccording to Dr. Smith, he received a call on 21 May saying he would not be needed \nat the office the following Monday, 24 May.  He then received a call that Monday afternoon \ninforming him that he had been relieved of his position with Rock Dental.  [TR at 22] \nDr.  Smith  underwent  a  corrective  procedure  for  his  back  issue  at  the  beginning  of \nJune 2021 and did not work again until “the end of the month,” after “recuperating enough” \nto begin working again.  [TR at 23]  He stated that he began doing contract work for Aspen \nDental Group in Hot Springs for about four (4) months before starting again with Jefferson \nComprehensive Care for another year or so.  At the time of the hearing, he said that he was \nworking for Guided Practice Solutions Southern Dental Group.  [TR at 24] \nThe claimant went on to say that he was taking Maxide to control his blood pressure \nand that he had not experienced any dizziness on the medication; but when asked if he had \never fallen due to dizziness on the medication, he answered, “No, not that I would say.” [TR \nat 24]  When asked if he had any symptoms due to medication prior to his fall in April, he \noffered, “Not that I can speak to.”  [TR at 25] He rated the pain he felt after falling as a nine \n(9) or ten (10) and said that he never experienced pain like that before.  Dr. Smith believes \nthat the corrective procedure was a success, though he experiences some reduction in range \nof motion, “which is part of being a dentist.” Id. \nB. Claimant on cross-examination by Mr. Wade: \n\nK. SMITH- H104308  \n5 \n \nRespondents’ counsel asked again about the morning of Dr. Smith’s fall, and Dr. Smith \nsaid again that he fell on his way to get a cup of tea and that he had not been light-headed or \ndizzy at the time.  Nor was there any hazard apparent on the floors.  [TR at 28]  He confirmed \nhis discharge from the emergency department (ED) on the same day that he arrived and that \nhe returned to work the following day, apparently without any further incident.  [TR at 29] \nDr. Smith eventually returned to Little Rock on Thursday, per usual. Other than some days \noff, he continued working in Helena until his release from employment with the respondent. \nId. \nDr. Smith confirmed that he sought chiropractic care before falling, and that “[Dr.] \nBlackmon  would  do  adjustments  on  you  and  kind  of  relieve  some  of  that  tenseness  and \nsoreness....” [TR at 30]   Dr. Blackmon’s treatments loosened tense areas and helped with \nthe claimant’s range of motion.  [TR at 31]  Dr. Smith also confirmed that he was taking no \nmedication as a result of the fall and that he had no work restrictions.  [TR at 31]  Referring \nback  to  his  deposition  and  being  asked  about  his  release  from  employment,  the  claimant \naffirmed that he was released because of a malpractice claim brought against him.  [TR at \n32] \nThe examination continued, referencing the EMS records from Pafford: \nQ:  It goes on to say that, “He states that just prior to falling he felt \ndizzy and light-headed.” Did you tell them that? \n \nA:  I don’t recall that. \n \nQ:  You don’t know one way or the other? \n \nA: No. \n. . .  \n \nQ:  ... at Helena Regional, do you remember describing the fact that you \nwere dizzy or giddy at the time? \n \nA:  I couldn’t say, Counselor. \n\nK. SMITH- H104308  \n6 \n \nQ:  Okay. Page 16 of the medical exhibit says: “This 65-year-old white \nmale dentist stood up, felt dizzy and lightheaded, and then fell to the \nfloor.” Do you know where  they would  have  gotten  that  history  if  not \nfrom you? \n \nA:  I’m not sure.  [TR at 34-35] \n \nThe cross-examination concluded with Dr. Smith stating that he did not return to Dr. \nHedges  or  anyone  else  at  the  family  medicine  clinic  after  the  outpatient  procedure  was \nperformed. Id. \nC.  Claimant on re-direct and re-cross: \nDr. Smith attributed the report of his “giddy” behavior after falling to experiencing a \n“range of emotions and behaviors because I was hurting.” [TR at 36.] His testimony concluded \nshortly afterwards, and he rested his case. \nD.  Respondent Mr. James “Jim” Cavanaugh, claims adjuster for carrier-respondent:  \nMr. Cavanaugh explained that Dr. Smith’s claim was assigned for his review and \ninvestigation.  [TR at 40]  He spoke with the claimant on 11 May 2021 and his notes\n1\n reflect \na  conversation  where  Dr.  Smith  relayed  going  to  the  breakroom  and  fainting  or  losing \nconsciousness.  [TR  at  43]  When  asked  again  about  the reported cause  of  the  fall, Mr. \nCavanaugh stated, “You know, in my note I asked him, you know, why did he fall. And you \nknow,  I  summarized  the  he  admitted  he was standing in the breakroom and fainting... it \nmight have likely been related to his blood pressure.”  [TR at 45] \nMr.  Cavanaugh  said that  calls  with claimants are sometimes  recorded,  but  the  call \nwith Dr. Smith was not and that he took notes instead.  He did not recall any medical records \nbeing available or made part of the claim file at the time of the call.  [TR at 48] \n E.  Claimant on rebuttal:  \n \n1\n Mr. Cavanaugh testified from his memory and refreshed his recollection with contemporaneous notes \nfrom the conversation with Dr. Smith. As he relied on the notes at times, a copy was provided to Dr. \nSmith’s counsel for is review. [TR at 44-45] \n\nK. SMITH- H104308  \n7 \n \n Dr. Smith testified briefly again after Mr. Cavanaugh’s testimony.  He recalled Mr. \nCavanaugh  as  rude  and  reiterated  that  he  did  not  recall  reporting  any  dizziness  or  blood \npressure problems related to his fall.  [TR at 52]  But when asked again about the medical \nreports  of  feeling  lightheaded,  dizzy,  and  giddy  and  whether  the  medical  providers  would \n“have gotten this information from anybody but you,” he responded that they would not.  [TR \nat 54] \n Upon brief examination from the bench, the claimant stated that he was familiar with \nHIPAA, that he had a chance to review his medical records, and that he had not attempted \nto exercise his right under HIPAA to correct or amend the medical records that he took issue \nwith  earlier  in  his  testimony.  [TR  at  55]  He  followed  that  by  saying  that  he  passed  his \nmedical records on to his counsel without reviewing them.  [TR at 56]  \nF.  Medical Records: \n  The  records  from  Pafford  show  that a  call  was  made  at  10:20  AM  and that the \nambulance arrived eight (8) minutes later.  See, Cl. Ex. No 1 at 1. The narrative portion of the \nrecord states that “just prior to falling he  felt  dizzy  and  lightheaded.  The [patient’s vital \nsigns] are stable other than his heart rate, which is noted to be bradycardic.” See, Cl. Ex. No \n1 at 3.  In addition to the basic cardiac monitor, a 12-lead ECG was placed during transport, \n“reading much clearer and showing sinus brady as well.” Id. \n His ED records show that he presented at 11:14 AM with back pain that began about \nan hour prior to admission.  He rated the pain at eight (8) out of ten (10).  See Cl. Ex. No 1 at \n20. The nurse’s notes show that he “felt dizzy and fell backwards hurting his back.” See, Cl. \nEx. No 1 at 20. The physician’s notes show that the claimant “stood up [and] felt dizzy and \nlightheaded, then fell to the floor.”  See, Cl.  Ex.  No  1  at  16. “Slight low back pain” was \ndescribed by the claimant, but on exam he exhibited “No spinal tenderness. No costovertebral \n\nK. SMITH- H104308  \n8 \n \ntenderness. Full range of motion.”  Id.  Ketorolac and then Norco were administered for pain. \nSee, Cl. Ex. No 1 at 21. Imaging was ordered and revealed no significant findings. See, Cl. Ex. \nNo 1 at 22-23.  \nHis  discharge  summary  shows  Dr. Smith’s diagnosis as “dizziness and giddiness; \nsprain of ligaments of lumbar spine” and that he was provided discharge instructions for \ndizziness and lumbar strain.  See, Cl. Ex. No 1 at 5.  The physician prescribed Naprosyn and \nNorco  for  pain  control.  Id.  Dr. Smith’s signature appears on the 19 April 2021 discharge \nform.  Id. \nThe claimant’s fist encounter note with Dr. Blackmon is dated 7 May 2021, and it \nreflects: \nKeith sought  treatment  today,  complaining  of  intermittent sharp  and \nthrobbing  discomfort of  the  low  back.  He  describes  that  the  discomfort \nincreases with movement. On a scale of 1 to 10, with 10 being the most severe, \nhe,  using  a  VAS,  describes  the  intensity  as  a  7  and  indicated  that  the \ndiscomfort occurs approximately 60% of the time. He states the discomfort is \nthe same since his last visit.  See, Cl. Ex. No 1 at 24 \n \nThe note reflects a diagnosis of “wedge compression fracture of T11-T12 vertebra,” but a \nseparate x-ray imaging report is not included; nor are a “scanned consultation” or “scanned \nexamination” that are mentioned in the note.  Id.  The claimant was directed to consult with \nfamily practice medicine for the spine condition. \n Dr. Smith presented to Dr. Hal Hedges at LRFP on 14 May 2021.  See, Cl. Ex. No 1 at \n25.  The clinic note shows that Dr. Smith presented to establish care and that he was seeking \npain  control  options  with  a  recent  fall  and  compression  fracture  diagnosis.  Dr. Hedges \nreviewed the x-rays and noted, “While there is some wedge deformity of T11, I think there is \na  superior  endplate  compression  fracture  of  T12,  instead.”  Id.  He  ordered  an  MRI  and \nplanned to arrange vertebroplasty if the MRI confirmed the compression fracture.  See, Cl. \nEx. No 1 at 26. \n\nK. SMITH- H104308  \n9 \n \n The  MRI  report  is  dated  20  May  2021  and,  indeed,  shows  a  superior  endplate \ncompression fracture at T12.  See, Cl. Ex. No 1 at 27-28.  Advanced facet arthropathy at L4-5 \nand L5-S1 was also found. \n The notes from CHI St. Vincent show that he presented on 1 June 2021 for a radiology \nprocedure to address “intractable back pain secondary to osteoporotic compression fracture.” \nSee, Cl.  Ex.  No  1  at  29-30.  The  report  indicated  that  the  pain  was  “unresponsive  to \nconservative  management,” that a back brace was not used, and that the pain “continued \ndespite therapy.”  See Cl. Ex. No 1 at 32. The discharge plan called for decreased activity for \nthe day, with “progressive activity to normal level tomorrow.”  See, Cl.  Ex.  No  1  at  31.  No \nmedications were prescribed at discharge. \n The claimant returned to Dr. Blackmon’s office on 10 June 2021, with complaints of \n“intermittent tightness, diffuse and tingling discomfort in the low back,” describing the pain \nas five (5) out of ten (10) and occurring fifty percent (50%) of the time.  See, Cl. Ex. No 1 at 34. \nHe stated that his discomfort was better than his last visit, but that his “low back and neck \nand shoulders are still very sore and he is leaving for Florida in the morning.” Id. Dr. \nBlackmon found: \n Hypertonicity in the following areas: left cervical dorsal area, left upper \nthoracic  area  and  lumbosacral  region.  Multiple  subluxations  with  spasm, \nhypomobility and end point tenderness were found at the following levels: C5, \nC7, T1, T2, T5, T7, L4, L5, sacrum, right pelvis and left pelvis. An extremity \nsubluxation was discovered and adjusted in the left shoulder and right knee. \n \n He  assessed,  “Keith  has  had  an  exacerbation.  These  are  episodic  marked \ndeterioration[s] of the patient’s condition due to acute flareups of the presenting conditions.” \nThe plan called for daily treatment for three (3) to five (5) days, then three (3) times per week \nfor three (3) to four (4) weeks, then twice per week for three (3) to four (4) weeks, then once \nper week for three (3) weeks, and then once every two (2) weeks. Id. \n\nK. SMITH- H104308  \n10 \n \n The next record from Dr. Blackmon is a letter dated 8 February 2023 that explained \nhe  saw  Dr.  Smith  one  additional  time  in  June  of  2021,  but  had  not  seen  him  again  until \nNovember of 2022.  See, Cl. Ex. No 1 at 335  \nIV.  ADJUDICATION \n The stipulated facts, as agreed during the prehearing conference, are outlined above.  \n It  is  settled  that  the  Commission,  with  the  benefit  of  being  in  the  presence  of  the \nwitness  and  observing  his  or  her  demeanor,  determines  a  witness’  credibility  and  the \nappropriate weight to accord their statements. See Wal-Mart Stores, Inc. v. VanWagner, 337 \nArk. 443, 448, 990 S.W.2d 522 (1999).   \nUnder Arkansas’ workers’ compensation laws, a worker has the burden of proving, by \na preponderance of the evidence, that he sustained a compensable injury as the result of a \nworkplace  incident.  Ark.  Code  Ann.  §  11-9-102(4)(E)(i).  A  compensable  injury  must  be \nestablished  by  medical  evidence  supported  by  objective  findings.  Ark.  Code  Ann.  §  11-9-\n102(4)(D). Objective  medical  findings  are  those  findings  that  cannot  come  under  the \nvoluntary  control of the  patient.  Ark.  Code  Ann.  §  11-9-102(16)(A)(i).  Causation  does  not \nneed to be established by objective findings when the objective medical evidence establishes \nthat an injury exists and other nonmedical evidence shows that it is more likely than not that \nthe injury was caused by an incident in the workplace. Bean v. Reynolds Consumer Prods., \n2022 Ark. App 276, 646 S.W.3d 655, 2022 Ark. App. LEXIS 276, citing Wal-Mart Stores, Inc. \nv. VanWagner, supra. \nHere,  the  claimant  alleges  that  his  back  injury  occurred  by  specific  incident.  The \nclaimant must establish four (4) factors by a preponderance of the evidence to prove a specific \nincident injury: (1) that the injury arouse during the course of employment; (2) that the injury \ncaused  an  actual  harm that  required medical  attention;  (3)  that  objective findings support \nthe medical evidence; and (4) that the injury was caused by a particular incident, identifiable \n\nK. SMITH- H104308  \n11 \n \nin  time  and  place.  See Cossey  v.  G.  A.  Thomas  Racing  Stable,  2009  Ark.  App.  666,5,  344 \nS.W.3d 684, 689. \nThe respondents denied Dr. Smith’s specific incident back injury claim, arguing that \nit occurred outside the course and scope and/or that it was idiopathic in nature. [TR at 5]  \nAn idiopathic injury is “one that is personal in nature or peculiar to the individual; \ntherefore,  it  is  not  work-related.” Bean, supra,  citing Little  Rock  Convention  &  Visitors \nBureau v. Pack, 60 Ark. App. 82, 959 S.W.2d 415 (1997). \nA. Claimant failed to prove, by a preponderance of the evidence, that he suffered a   \ncompensable injury. \n \nBased on the evidence before me, I do not find it more likely than not that the claimant \nsuffered a compensable back injury.  \nFirst, I did not find the claimant’s testimony to be credible and, accordingly, give it \nlittle weight. There is no dispute that the claimant fell at work on a Monday morning. The \nexact circumstances around that fall are unclear, and the claimant brings his credibility into \nquestion  largely  in  that  regard.  He  stated  that  he  tripped  over  a  chair,  but  he  refused  to \naccept  as  accurate several contemporaneous statements  credited  to  him regarding  his  fall.  \nIn his reports to the EMS service, the ED nurse, and the attending physician, the medical \nrecords all reflect feelings of dizziness and/or lightheadedness immediately prior to his fall. \nHe stated that he had no recollection of such reports, but acknowledged that he was the only \nperson  who  would  have  offered the  information.  When  asked  on  cross-examination  if  he \nremembered  describing  feeling  dizzy  or  giddy  to  the  ED  staff,  he  evasively  responded, “I \ncouldn’t say, Counselor.” \nThe  fall  happened  around  8:30  AM,  and  the  ambulance  report  shows  the  crew \nencountering  the  patient  two (2) hours later. The 11:14 AM nurse’s note indicates that he \nreported feeling dizzy and falling backwards. About ten (10) minutes later, the physician’s \n\nK. SMITH- H104308  \n12 \n \nnote records that he felt dizzy and lightheaded and fell to the floor.  At one point he appears \nto attribute anything said or done after falling to his being in pain.  At another he said he \nwas sort of in shock and doesn’t really remember the details after falling.  He reported no \nsort of head injury and showed no signs of distress or cognitive impairment at any point in \nhis treatment. \nGiven the timeline between the fall and the multiple reports to medical providers that \nhe felt dizzy and lightheaded before falling, that he made no reports of and displayed no signs \nof cognitive impairment,  and  that  he performed  dentistry,  apparently  without  issue, on  at \nleast one patient to whom he had administered anesthesia prior to falling, I cannot credit his \nstatements  that  he  had  no  recollection  of  reporting  feeling  dizzy  or  lightheaded  prior  to \nfalling.   Similarly, I  struggle  to  accept  his  position  that  he was  unaware that  his medical \nrecords  reflected  assessments  of  dizziness,  when  the same  appears  on  the  discharge \ninstructions  that  bear  his  signature.  Moreover,  the  contemporaneous  notes  from  the \ninsurance adjuster (whose testimony I found credible) reflect that Dr. Smith fainted or lost \nconsciousness and made no mention of tripping over a chair. Given the answers he offered \nand his demeanor around this line of testimony, I find his testimony to lack credibility.\n2\n \nAffording little evidentiary value to the claimant’s version of the facts, I turn to the \navailable medical evidence. The law requires that I weigh medical evidence as I must weigh \nany other evidence. See Beliew v. Lennox Indus., 2010 Ark. App. 112, 2010 Ark. App. LEXIS \n95.  Where evidence may be conflicting, I am to attempt to reconcile the same and determine \nthe true facts. Id., citing Hargis Transp. V. Chesser, 87 Ark. App. 301, 190 S.W.3d 309 (2004). \n \n2\n Additionally, while it is not in my view directly related to whether he sustained a compensable injury, \nit does speak to his credibility that Dr. Smith likened his beginning work again at the end of June as \n“having recuperated enough where I could begin to work.” This weeks’ long convalescence does not \nring consistent with the discharge summary from his outpatient procedure that called for a return to \nnormal  activity  the  following  day.  It  does,  I  find,  call  further  into  question  his  candor  in  testifying \nbefore the Commission. \n\nK. SMITH- H104308  \n13 \n \nThe following facts are uncontested: the claimant fell while at work in April, he was \ndiagnosed with a compression fracture in May, and he underwent an outpatient procedure to \naddress the compression fracture in June.  On the one hand, the contemporaneous medical \nrecords from  HRMC show  no  significant  findings  of acute  injury.  On  the  other  hand,  the \nclaimant  presented  to  Dr.  Blackmon  several  weeks  after  falling  and  imaging  revealed a \ncompression fracture of his thoracic vertebra.  That 7 May 2021 record makes no mention of \na fall or any other attempt towards discussing or identifying a mechanism of injury.  Indeed, \nthe note makes clear that “the discomfort is the same since his last visit,” and Dr. Smith \nagreed  on  the  stand  that  he  sought  chiropractic  care prior  to  his  fall.  In  fact,  despite  Dr. \nSmith feeling that the procedure for his compression fracture was a success, he still went on \nafterwards to seek more chiropractic care from Dr. Blackmon, who charted an extensive list \nof objective findings and a months’ long treatment plan for the same.  \nI  do  not  find  objective  evidence  to  support  a  finding  that  Dr. Smith  suffered  a \ncompensable back injury when he fell at work.  The procedure notes appear to reflect a more \nchronic  condition  and  pain  presentation.  “Intractable  pain  related  to  osteoporotic \ncompression  fracture,  unresponsive  to  conservative  management... Pain  has  not  been \nrelieved by conservative measures... Pain has continued despite therapy.” Relevant records \nprior to Dr. Smith’s fall are not available for comparison. But even in the absence of those, I \nfind that it is more likely than not that the compression fracture found in May and treated \nin June of 2021 was idiopathic and not caused by his falling in April.  \nB. Benefits \n \n Because he failed to prove a compensable injury, the claimant’s request for reasonable \nand necessary medical treatment and TTD benefits are moot. \n C.  Attorney’s Fee \n In accordance with the above, the claimant is not entitled to an attorney’s fee. \n\nK. SMITH- H104308  \n14 \n \nV.  ORDER \n Consistent with the findings of fact and conclusions of law set forth above, this claim \nis denied and dismissed. \nSO ORDERED. \n \n________________________________ \n       JAYO. HOWE \n       ADMINISTRATIVE LAW JUDGE","preview":"BEFORE THE ARKANSAS WORKERS’ COMPENSATION COMMISSION AWCC FILE No H104308 KEITH W. SMITH, EMPLOYEE CLAIMANT ROCK DENTAL ARKANSAS, PLLC, AXPM DENTAL MANAGEMENT, EMPLOYER RESPONDENT CINCINNATI CASUALTY Co./CINCINNATI INSURANCE, CARRIER, CARRIER/TPA RESPONDENT OPINION FILED 27 JULY 2023 On hearing before Arkansas Workers’...","fetched_at":"2026-05-19T23:05:50.135Z","links":{"html":"/opinions/alj-H104308-2023-07-27","pdf":"https://labor.arkansas.gov/wp-content/uploads/SMITH_KEITH_H104308_20230727.pdf","source_publisher":"https://labor.arkansas.gov/workers-comp/awcc-opinions/administrative-law-judge-opinions/"}}